Pulmonology Book


Asthma Inhaler Education

Aka: Asthma Inhaler Education, Inhaler, Metered Dose Inhaler, MDI Proper Use, Inhaler Proper User, Dry Powder Inhaler, Dry Powder Inhaler Formulations, Soft Mist Inhaler, Smart Inhaler Technology, Inhaler Cleaning, Inhaler Education
  1. See Also
    1. Spacer Devices for Asthma Inhalers
  2. Precautions
    1. Each Inhaler type has unique best usage recommendations
    2. Try to prescribe Inhalers with the same delivery methods to optimize compliance
    3. Inhaler Cleaning (prevent clogging)
      1. Clean Inhalers at least weekly
      2. Albuterol HFA
        1. Clogging may appear as white residue at MDI spray nozzle
        2. Remove Canister and avoid getting wet
        3. Rinse mouthpiece top and bottom under Running water for 30 seconds each, then dry
      3. Other Inhalers
        1. Discuss with pharmacist or follow manufacturer instructions
        2. Many of the devices (e.g. Symbicort) do not allow for removal of canister
        3. May wipe any mouthpiece with dry cloth to clean
        4. Avoid moisture around Dry Powder Inhalers
      4. References
        1. (2020) presc lett 27(9): 54
  3. Technique: Aerosol or HFA propellant Metered Dose Inhaler (e.g. Albuterol MDI, Proair, Qvar)
    1. Preparation
      1. Shake before use (mixes medication and propellant)
      2. Uncap Inhaler
      3. Prime once before first use
      4. Attach Inhaler Spacer
    2. Take a deep breath and then exhale all air out
    3. Place Inhaler with spacer to lips
    4. Start to breath in while pressing the Inhaler to release medication
    5. Inhale slowly and deeply and then hold breath for 10 seconds
  4. Technique: Dry Powder Inhaler (e.g. Advair, Flovent Diskus, Serevent, Asmanex, Spiriva)
    1. Precautions
      1. Never take the powders orally (and keep separate from oral medications)!
      2. Do not shake before use (contrast with MDI)
    2. Preparation
      1. Uncap the device
      2. Load the powder caps or other formulation as directed
      3. No Inhaler Spacer is needed
    3. Inhalation
      1. Exhale fully
      2. Place Inhaler with spacer to lips, holding it in level position
      3. Start to breath in while pressing the Inhaler to release medication
        1. Device punctures medication casing exposing the powder
      4. Inhale deeply, and in contrast to MDI, inhale rapidly
      5. Then hold breath for 10 seconds
      6. Then expire all air out and avoid exhaling on device (prevents wetting the powder)
    4. Device types
      1. Single-dose device (e.g. aerolizer, handihaler)
        1. One dose capsule inserted into device, punctured and inhaled once or twice
      2. Multi-dose device (e.g. Discus, Flexhaler, Twisthaler)
        1. Dose is advanced (specific to device) and then capsule punctured and inhaled
  5. Technique: Soft Mist Inhalers (e.g. Combivent Respimat)
    1. Spring-loaded device without propellant
    2. No shaking of suspension required
    3. Exhale, then press down on Inhaler while breathing in slowly and deeply and then hold breath for 10 seconds
  6. Preparations: Adjuncts
    1. Smart Inhaler Technology
      1. Add-on sensors (e.g. Hailie, Propeller) attach to Inhalers (or built in sensor for Proair Digihaler)
      2. Sensors relay Inhaler use and inspiratory flow to synchronized mobile applications
      3. May increase Inhaler compliance, but cost $160 and typically not covered by insurance
      4. (2019) Presc Lett 26(7): 41
  7. References
    1. (2014) Presc Lett 21(2): 9
    2. (2017) Presc Lett 24(1): 3-4

Inhaler (C0021461)

Definition (HL7V3.0) <p>A small device used for inhaling medicine in the form of a vapour or gas in order to ease a respiratory condition such as asthma or to relieve nasal congestion.</p>
Definition (HL7V3.0) <p>A small device used for inhaling medicine in the form of a vapour or gas in order to ease a respiratory condition such as asthma or to relieve nasal congestion.</p>
Definition (NCI) A device by means of which a medicinal product can be administered by inspiration through the nose or the mouth.
Definition (NCI_NCI-GLOSS) A device for giving medicines in the form of a spray that is inhaled (breathed in) through the nose or mouth. Inhalers are used to treat medical problems such as bronchitis, angina, emphysema, and asthma. They are also used to help relieve symptoms that occur when a person is trying to quit smoking.
Concepts Medical Device (T074)
MSH D009330
SnomedCT 420317006, 334980009
HL7 2.16.840.1.113883.1.11.16196, INH
English Inhalator, Inhalators, Inhaler (product), Inhaler (qualifier value), INHALER, Inhaler [Dose Form], inhalators, inhaler, inhalers, InhalerMedicalDevice, Inhaler (physical object), INHALER (EA), INHALER (ML), Inhalers, Inhaler
Czech inhalátory
Portuguese Inaladores
Spanish inhalador (calificador), inhalador (producto), Inhaladores, inhalador (objeto físico), inhalador
German Inhaliergeräte, Inhalatoren
French Inhalateurs
Italian Inalatori
Norwegian Inhalatorer, Sprayinhalatorer
Dutch Inhalatoren
Derived from the NIH UMLS (Unified Medical Language System)

Metered Dose Inhaler (C0993596)

Definition (MSH) A small aerosol canister used to release a calibrated amount of medication for inhalation.
Definition (NCI) A liquid medication delivered as a mist to be inhaled as a measured dose
Concepts Medical Device (T074)
MSH D036501
SnomedCT 422059006
English Metered dose inhaler, Metered dose inhaler (product), Metered dose inhaler (qualifier value), Metered Dose Inhaler [Dose Form], Metered Dose Inhaler, mdi inhaler, mdi inhalers, meter dose inhaler, metered dose inhalers, dose inhalers meter, metered dose inhaler, MDI, Metered Dose Inhaler Dosage Form, Metered Dose Inhaler Dose Form, Inhaler, Metered Dose, Inhalers, Metered Dose, MDI (Inhalers), Metered Dose Inhalers, Metered-dose inhalers
Spanish inhalador de dosis fija, inhalador de dosis fija (producto), inhalador de dosis fija (calificador), Aerosoles Dosimetrados, Inhaladores de Medida Dosificada, Inhaladores Dosimetrados, Inhaladores de Dosis Medida
Swedish Dosreglerade inhalatorer
Czech dávkovací inhalátory
Finnish Annosinhalaattorit
Japanese 定量噴霧型吸入器, 噴霧型吸入器-定量, スペーサー吸入器, 吸入器-定量, 計量式吸入器, 定量吸入器, 吸入器-計量式
Italian Inalatori MDI, Inalatori a dosi fisse, Turbohaler, Inalatori multidose
French Sprays doseurs, Aérosols-doseurs, Inhalateurs-doseurs, Nébuliseurs-doseurs, Nébulisateurs-doseurs
Polish Inhalatory dawkujące
Norwegian Inhalatorer med dosering
Portuguese Aerossóis Dosificadores, Aerossóis Dosimetrados, Inaladores Dosimetrados, Inaladores de Dose Medida
German Dosieraerosole
Dutch Inhalers, metered dose, Metered dose inhalers
Derived from the NIH UMLS (Unified Medical Language System)

Dry Powder Inhaler (C1967611)

Definition (MSH) A device that delivers medication to the lungs in the form of a dry powder.
Definition (NCI) Powder intended for oral inhalation.
Concepts Medical Device (T074)
MSH D058995
English Dry Powder Inhaler [Dose Form], Dry Powder Inhalers, Inhaler, Dry Powder, Powder Inhaler, Dry, Inhalers, Dry Powder, Powder Inhalers, Dry, Powder Inhaler Dose Form, Powder Inhaler Dosage Form, Dry Powder Inhaler, Powder Inhaler
French IPS (Inhalateur à Poudre Sèche), Inhalateurs de poudre sèche, Inhalateurs à poudre sèche
German Inhalatoren, Trockenpulver, Trockenpulverinhalatoren
Czech práškové inhalátory
Italian Inalatori di polvere secca, Inalatori di polveri, Inalatori a polvere secca
Spanish Inhaladores de Polvo Seco
Portuguese Inaladores de Pó Seco
Polish Inhalatory suchego proszku
Norwegian Pulverinhalatorer
Derived from the NIH UMLS (Unified Medical Language System)

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