Correct Use of Inhalers

Transcription

1 This Clinical Resource gives subscribers additional insight related to the Recommendations published in January 2017 ~ Resource # Correct Use of Inhalers As few as one-half to one-third of patients who are prescribed s may be using them correctly, depending on the type of. 1 The different types of devices are likely to be equally effective in delivering medication when used correctly. 1,2 Therefore, take advantage of educational opportunities to assess technique and ensure adequate medication delivery. Education and repetitive demonstration are key to proper technique. 3 When choosing a device for a patient consider the availability of the desired medication in the desired device, patient s ability to use the device properly (e.g., cognition, dexterity, strength), patient preference, and cost. 1,2 There are nuances with each type of device. For example, metered-dose s (MDIs) usually require priming and shaking prior to use and good hand-breath coordination (although the use of a spacer may help with this). 1 Dry-powder s (DPIs) are breath-activated but do not require the same hand-breath coordination as MDIs. DPIs may not be best for patients who cannot produce an adequate inhalation (e.g., very young children) and must be stored in a dry area. 3 Detailed information for use and care of these s is found in the product s packaging (e.g., patient information leaflets, MedGuides). Use CPT code to bill for teaching. We have therapeutic information about different s in our charts, Inhalers for COPD and Comparison of Inhaled Asthma Meds, and a patient education handout, Tips for Correct Use of Inhalers. The chart below includes steps for use as well as links to instructional videos, information on how to obtain a demo to teach patients, and details about priming and cleaning the devices. Metered-Dose Inhaler (MDI) Breathing techniques: There are two different techniques used with MDIs when not using a spacer, open-mouth and closed-mouth. 4 Open-mouth technique was primarily recommended for use with MDIs containing chlorofluorocarbon (CFC) propellants. 4 All MDIs are now made with hydrofluoroalkane (HFA) propellants instead and manufacturers recommend a closed-mouth technique. 4 Data are not consistent on which technique is most effective or appropriate: 4 o Open-mouth technique may provide higher drug delivery to the lungs compared to closed-mouth. 5,6 o Other research suggests no advantages with open-mouth technique, but express concern about accurate aiming with the open-mouth technique. 7,8 Observe patient demonstrations regardless of technique used, in order to provide feedback to improve medication delivery. 4 The steps below outline the closed-mouth technique as recommended by current MDI manufacturers. General steps for use (closed mouth without spacer, includes changes needed for patients using a spacer): 3 1. Shake the well, if necessary (noted for each individual brand of in rows below). (If not using a spacer, move to step 3.) 2. If using a spacer: attach the spacer and the together, with the s canister in a vertical position 3. Breathe out fully through the mouth, away from the 4. Put the mouthpiece in the mouth and tighten the lips around it. (If not using a spacer, move to step 6.) OR

2 (Clinical Resource #330106: Page 2 of 15) 5. If using a spacer: put the mouthpiece of the spacer between the teeth and tighten the lips around it (or if you use a spacer with a mask, position the mask over the nose and mouth and make sure there s a tight seal against the cheeks and chin) 6. Press the canister down while inhaling deeply and slowly through the mouth 7. Remove the from the mouth. (If not using a spacer, move to step 9.) OR 8. If using a spacer: move the mouthpiece away from the mouth 9. Hold the breath for as long as comfortably possible, generally up to ten seconds and then breathe out 10. Wait before repeating, usually 30 to 60 seconds Instructional video: Brands (MDI) Additional Info a,b To request a demo Advair HFA fluticasone/salmeterol Aerospan flunisolide Alvesco ciclesonide Atrovent HFA ipratropium Shake before use? Yes Priming: Before first use: four sprays. If not used for >4 weeks, or if drop : two sprays. Cleaning: Weekly after evening dose. Wipe the area where the spray comes out with a dry cotton swab. Wipe the inside of the mouthpiece with a damp tissue. Allow to dry overnight. Shake before use? Yes Priming: Before first use or if not used for >2 weeks: two sprays Cleaning: No Dose counter: No Priming: Before first use, or if not used for >10 days: three sprays Cleaning: Weekly. Wipe inside and out with a dry tissue. Priming: Before first use, or if not used for >3 days: two sprays Cleaning: Weekly. Remove dust cap and canister. Wash the mouthpiece with warm running water for at least 30 seconds. Shake to remove excess water and allow to air dry. Call Meda at

3 (Clinical Resource #330106: Page 3 of 15) Brands (MDI) Additional Info a,b To request a demo Shake before use? Yes Priming: Before first use: four sprays. If not used for >7 days: two sprays. Cleaning: Weekly. Remove dust cap and canister. Wash the mouthpiece with warm running water for at least 30 seconds. Shake to remove excess water and allow to air dry overnight. Bevespi Aerosphere* glycopyrrolate/formoterol *anticipated availability is early 2017 Dulera mometasone/formoterol Flovent HFA fluticasone propionate ProAir HFA albuterol Shake before use? Yes Priming: Before first use, or if not used for >5 days: four sprays Cleaning: Weekly. Wipe inside and out with a dry tissue. Shake before use? Yes Priming: Before first use: four sprays. If not used for >7 days, or if is dropped: one spray. Cleaning: Weekly after evening dose. Wipe the area where the spray comes out with a damp cotton swab. Wipe the inside of the mouthpiece with a damp tissue. Allow to dry overnight. Shake before use? Yes Priming: Before first use or if not used for >14 days: three sprays Cleaning: At least weekly. Remove the dust cap and canister. Wash the mouthpiece with warm running water for at least 30 seconds. Turn the mouthpiece upside down and repeat. Shake to remove excess water and allow to air dry. Replace canister. Shake well and spray two times into the air. Replace cap.

4 (Clinical Resource #330106: Page 4 of 15) Brands (MDI) Additional Info a,b To request a demo Proventil HFA albuterol Shake before use? Yes Priming: Before first use, or if not used for >14 days: four sprays Cleaning: At least weekly. Remove the dust cap and canister. Wash the mouthpiece with warm running water for at least 30 seconds. Shake to remove excess water and allow to air dry. Replace canister and cap. Dose counter: No QVAR beclomethasone dipropionate Symbicort budesonide/formoterol Ventolin HFA albuterol Priming: Before first use or if not used for >10 days: two sprays Cleaning: Weekly. Wipe inside and out with a dry tissue. Shake before use? Yes Priming: Before first use, if not used for >7 days, or if dropped: two sprays Cleaning: Weekly. Wipe inside and out with a dry tissue. Beyond-use date: Three months after removal from foil pouch Shake before use? Yes Priming: Before first use, if not used for >14 days, or if dropped: four sprays Cleaning: At least weekly. Remove the dust cap and canister. Wash the mouthpiece with warm running water for at least 30 seconds. Turn the mouthpiece upside down and repeat. Shake to remove excess water and allow to air dry. Replace canister. Shake the well and spray once into the air. Replace cap. Beyond-use date: 12 months after removal from foil pouch Call AstraZeneca at

5 (Clinical Resource #330106: Page 5 of 15) Brands (MDI) Additional Info a,b To request a demo Xopenex HFA levalbuterol Shake before use? Yes Priming: Before first use or if not used for >3 days: four sprays Cleaning: At least weekly. Remove the dust cap and canister. Wash the mouthpiece with warm running water for at least 30 seconds. Turn the mouthpiece upside down and repeat. Shake to remove excess water and allow to air dry. Replace canister. Shake the well and spray once into the air. Replace cap. Dose counter: No Soft-Mist Inhaler General steps for use: Hold the upright Turn the base in the direction of the arrows until it clicks Flip the cap until it snaps open Breathe out fully through the mouth, away from the Put the mouthpiece in the mouth and tighten the lips around the end without covering the air vents Press the dose release button and inhale deeply and slowly through the mouth Hold the breath as long as comfortably possible, up to ten seconds Instructional videos: Brands (Soft-Mist Inhaler) Additional Info a,b To request a demo Combivent Respimat albuterol/ipratropium Priming: Before first use, or if not used for >21 days: Spray into the air until a visible spray is seen. Spray three more times. If not used for >3 days: one spray. Cleaning: At least weekly. Wipe the mouthpiece inside and out with a damp tissue. Beyond-use date: Three months after assembly of device Call Boehringer Ingelheim at

6 (Clinical Resource #330106: Page 6 of 15) Brands (Soft-Mist Inhaler) Additional Info a,b To request a demo Spiriva Respimat tiotropium Priming: Before first use, or if not used for >21 days: Spray into the air until a visible spray is seen. Spray three more times. If not used for >3 days: one spray. Cleaning: At least weekly. Wipe the mouthpiece inside and out with a damp tissue. Beyond-use date: Three months after assembly of device Call Boehringer Ingelheim at Stiolto Respimat tiotropium bromide and olodaterol Striverdi Respimat olodaterol Priming: Before first use, or if not used for >21 days: Spray into the air until a visible spray is seen. Spray three more times. If not used for >3 days: one spray. Cleaning: At least weekly. Wipe the mouthpiece inside and out with a damp tissue. Beyond-use date: Three months after assembly of device Priming: Before first use, or if not used for >21 days: Spray into the air until a visible spray is seen. Spray three more times. If not used for >3 days: one spray. Cleaning: At least weekly. Wipe the mouthpiece inside and out with a damp tissue. Beyond-use date: Three months after assembly of device Call Boehringer Ingelheim at Call Boehringer Ingelheim at Dry-Powder Inhaler (DPI): Diskus General steps for use: After opening the with the thumb grip, hold the flat and level, and slide the lever from left to right until it clicks Breathe out fully through the mouth, away from the Put the mouthpiece in the mouth and tighten the lips around it Inhale quickly and deeply through the mouth Remove the device from the mouth and hold the breath as long as comfortably possible, up to ten seconds Instructional video:

7 (Clinical Resource #330106: Page 7 of 15) Brands (DPI; Diskus) Additional Info a,b To request a demo Advair Diskus fluticasone/salmeterol Cleaning: No Beyond-use date: One month after removal from foil pouch Contact a GlaxoSmithKline sales representative by calling Flovent Diskus fluticasone Serevent Diskus salmeterol Cleaning: No Beyond-use date: Six weeks after removal from foil pouch (50 mcg strength) and two months after removal from foil pouch (100 mcg and 250 mcg strength) Cleaning: No Beyond-use date: Six weeks after removal from foil pouch Contact a GlaxoSmithKline sales representative by calling Contact a GlaxoSmithKline sales representative by calling Dry-Powder Inhaler (DPI): Ellipta General steps for use: Slide the cover down to reveal the mouthpiece Breathe out fully through the mouth, away from the Put the mouthpiece between the lips Do not block the air vents with the fingers Breathe in deeply and slowly through the mouth Remove the from the mouth and hold the breath for three or four seconds or as long as comfortably possible Instructional video:

8 (Clinical Resource #330106: Page 8 of 15) Brands (DPI; Ellipta) Additional Info a,b To request a demo Anoro Ellipta umeclidinium/vilanterol Cleaning: Wipe mouthpiece with a dry tissue before closing the if desired Beyond-use date: Six weeks after removal from foil tray Contact a GlaxoSmithKline sales representative by calling Arnuity Ellipta fluticasone Breo Ellipta fluticasone/vilanterol Incruse Ellipta umeclidinium Cleaning: Wipe mouthpiece with a dry tissue before closing the if desired Beyond-use date: Six weeks after removal from foil tray Cleaning: Wipe mouthpiece with a dry tissue before closing the if desired Beyond-use date: Six weeks after removal from foil tray Cleaning: Wipe mouthpiece with a dry tissue before closing the if desired Beyond-use date: Six weeks after removal from foil tray Contact a GlaxoSmithKline sales representative by calling Contact a GlaxoSmithKline sales representative by calling Contact a GlaxoSmithKline sales representative by calling Dry-Powder Inhaler (DPI): Flexhaler General steps for use: Hold the upright and remove the cap Holding the in the middle, twist the grip as far as it will go in one direction, then back in the other direction until it clicks Breathe out fully through the mouth, away from the Put the mouthpiece in the mouth and tighten the lips around it Breathe in deeply and forcefully through the mouth Instructional video:

9 (Clinical Resource #330106: Page 9 of 15) Brands (DPI; Flexhaler) Additional Info a,b To request a demo Pulmicort Flexhaler budesonide Priming: Before first use. Twist the grip in one direction, then back in the other direction until a click is heard one time. Cleaning: Weekly, clean the outside of the device with a dry tissue Call AstraZeneca at Dry-Powder Inhaler (DPI): Diskhaler General steps for use: Pull the mouthpiece all the way out, press in the raised ridges on the outside edges of the mouthpiece, and pull the whole tray out Place one medicine disk onto the wheel, flat side up Push the tray back into the body of the as far as it will go Lift the half-circle flap on top of the to a straight-up position and then click the flap back into place Breathe out fully through the mouth, away from the Place the mouthpiece in the mouth, keeping the level Tighten the lips around the mouthpiece without covering the small holes on its sides Breathe in steadily and deeply through the mouth and hold the breath for a few seconds Instructional video: Brands (DPI; Diskhaler) Additional Info a,b To request a demo Relenza Diskhaler zanamivir Cleaning: No Dose counter: No

10 (Clinical Resource #330106: Page 10 of 15) Dry-Powder Inhaler (DPI): HandiHaler General steps for use: Remove the cap by pressing the piercing button Pull the lid away from the to expose the mouthpiece Expose the center chamber by pulling the mouthpiece up and away from its base Place one capsule (removed from its foil blister) in the center chamber of the and close the mouthpiece until it clicks Continue to hold the with the mouthpiece pointed up, press the button on the side once, then release it Breathe out fully through the mouth, away from the Place the in a horizontal position and place the mouthpiece in the mouth, tightening the lips around it Breathe in deeply through the mouth and hold the breath for a few seconds Remove the mouthpiece from the mouth Repeat the steps starting with Breathe out fully through the mouth a second time Open the mouthpiece, remove the used capsule, and discard it Instructional video: Brands (DPI; HandiHaler) Additional Info a,b To request a demo Spiriva HandiHaler tiotropium Cleaning: After each use: empty the remains of the capsule from the into the trash. Before closing the mouthpiece or cap, turn the upside down and tap it firmly yet gently to remove any residue. As needed: open the cap and mouthpiece. Open the base by lifting the piercing button. Rinse the with warm running water. Leave it open to air dry for 24 hours. Dose counter: No Call Boehringer Ingelheim at

11 (Clinical Resource #330106: Page 11 of 15) Dry-Powder Inhaler (DPI): Neohaler General steps for use: Remove one capsule from its foil blister and place the capsule into the capsule chamber Click the closed Hold the upright and press the buttons on the sides, both at one time, until a click is heard, then release Breathe out fully through the mouth, away from the Place the mouthpiece in the mouth and breathe in rapidly and steadily through the mouth and hold the breath as long as comfortably possible Open to see if any powder remains in the capsule. If yes, close and repeat steps starting with Breathe out fully through the mouth. Open the mouthpiece, remove the used capsule, and discard it Instructional video: Brands (DPI; Neohaler) Additional Info a,b To request a demo Arcapta Neohaler indacaterol Cleaning: Wipe with a clean dry lint-free cloth between uses if desired Dose counter: No Utibron Neohaler* indacaterol/glycopyrrolate *anticipated availability late 2016 or early Cleaning: Wipe with a clean dry lint-free cloth between uses if desired Dose counter: No

12 (Clinical Resource #330106: Page 12 of 15) Dry-Powder Inhaler (DPI): Podhaler General steps for use: After removing the lid, stand the upright on its base, hold the body of the, and unscrew the mouthpiece. Set the mouthpiece aside. Tear off one blister card, roll back the foil, take the capsule out of the blister, and place it in the capsule chamber of the Put the mouthpiece back on the and screw it closed Hold the with the mouthpiece pointing down and press the button on the end of the all the way down one time Breathe out fully through the mouth, away from the mouthpiece Place the mouthpiece in the mouth and breathe in deeply through the mouth Remove the from the mouth and hold the breath for about five seconds Take a few normal breaths, and then repeat the steps starting with Breathe out fully through the mouth. Open the mouthpiece, remove the used capsule from the, and discard it Replace the mouthpiece and wipe it with a clean dry cloth Instructional video: Brands (DPI; Podhaler) Additional Info a,b To request a demo Tobi Podhaler tobramycin Cleaning: No. However, one extra device is included with every 28-day supply in case the device becomes wet, dirty, or broken; is dropped; or malfunctions. Dose counter: No Call Novartis at Dry-Powder Inhaler (DPI): Pressair General steps for use: After removing the cap, hold the with the mouthpiece facing the mouth and the button on the top Press the button all the way down and release it Breathe out completely through the mouth, away from the Place the mouthpiece in the mouth, tighten the lips around it, and breathe in quickly and deeply through the mouth, until the lungs are filled Remove the from the mouth and hold the breath for as long as is comfortably possible Instructional video:

13 (Clinical Resource #330106: Page 13 of 15) Brands (DPI; Pressair) Additional Info a,b To request a demo Tudorza Pressair aclidinium bromide Call AstraZeneca at Cleaning: If desired. Clean the outside of the mouthpiece with a dry tissue or paper towel. Beyond-use date: 45 days after removal from foil pouch Dry-Powder Inhaler (DPI): RespiClick General steps for use: Hold the upright and open the cap fully, until you hear a click Breathe out completely through the mouth, away from the Place the mouthpiece in the mouth and tighten the lips around it, without blocking the vent above the mouthpiece Breathe in deeply through the mouth, until the lungs are filled Remove the from the mouth and hold the breath for as long as is comfortably possible Check the dose counter to make sure the dose was received Instructional video: Brands (DPI; RespiClick) Additional Info a,b To request a demo ProAir RespiClick Albuterol Cleaning: Wipe mouthpiece with a dry cloth or tissue if it appears to need cleaning Beyond-use date: 13 months after removal from foil pouch Dry-Powder Inhaler (DPI): Twisthaler General steps for use: Hold the upright and remove the cap by twisting it in a counterclockwise direction Breathe out fully through the mouth, away from the Place the mouthpiece in the mouth and tighten the lips around it, holding the in a horizontal position Do not cover the ventilation holes and breathe in quickly and deeply through the mouth Remove the from the mouth and hold the breath as long as comfortably possible, up to ten seconds Replace the cap, turning it in a clockwise direction and gently pressing it down, until a click is heard Instructional video: Call Teva Select option #3

14 (Clinical Resource #330106: Page 14 of 15) Brands (DPI; Twisthaler) Additional Info a,b To request a demo Asmanex Twisthaler mometasone Cleaning: Wipe mouthpiece dry after each use Beyond-use date: 45 days after removal from foil pouch a. Note that instructions for device use and care are specific to the listed brand name product. Instructions for use/care of generic devices may differ. b. Beyond-use date: the date after which a medication should not be used. This may be sooner than the manufacturer s expiration date, if a medication is less stable after it is mixed, removed from protective packaging, etc. U.S. product information used for preparation of the above chart: Advair Diskus (April 2016); Advair HFA (December 2014); Aerospan (June 2015); Alvesco (January 2013); Anoro Ellipta (February 2016); Arcapta Neohaler (September 2012); Arnuity Ellipta (November 2014); Asmanex Twisthaler (September 2014); Atrovent HFA (August 2012); Bevespi Aerosphere (April 2016); Breo Ellipta (July 2016); Combivent Respimat (June 2016); Dulera (July 2016); Flovent Diskus (September 2016); Flovent HFA (December 2014); Incruse Ellipta (February 2016); ProAir HFA (June 2016); ProAir RespiClick (April 2016); Proventil HFA (December 2014); Pulmicort Flexhaler (July 2010); QVAR (July 2014); Relenza Diskhaler (August 2016); Serevent Diskus (September 2016); Spiriva HandiHaler (January 2016); Spiriva Respimat (June 2016); Stiolto Respimat (June 2016); Striverdi Respimat (June 2016); Symbicort (February 2016); Tobi Podhaler (October 2015); Tudorza Pressair (March 2016); Utibron Neohaler (January 2016); Ventolin HFA (December 2014); Xopenex HFA (March 2015). Users of this resource are cautioned to use their own professional judgment and consult any other necessary or appropriate sources prior to making clinical judgments based on the content of this document. Our editors have researched the information with input from experts, government agencies, and national organizations. Information and internet links in this article were current as of the date of publication.

15 (Clinical Resource #330106: Page 15 of 15) Project Leader in preparation of this clinical resource (330106): Beth Bryant, Pharm.D., BCPS, Assistant Editor References 1. Barrons R, Pegram A, Borries A. Inhaler device selection: special considerations in elderly patients with chronic obstructive pulmonary disease. Am J Health Syst Pharm 2011;68: Dolovich MB, Ahrens RC, Hess DR, et al. Device selection and outcomes of aerosol therapy: evidence-based guidelines. Chest 2005;127: Gardenhire DS, Ari A, Hess D, Myers TR. A guide to aerosol delivery devices for respiratory therapists, 3 rd edition. American Association for Respiratory Care. (Accessed October 27, 2016). 4. Gregory KL, Elliott D, Dunne P. Guide to aerosol delivery devices for physicians, nurses, pharmacists, and other health care professionals ide_pro.pdf. (Accessed November 8, 2016). 5. Dolovich M, Ruffin RE, Roberts R, Newhouse MT. Optimal delivery of aerosols from metered dose s. Chest 1981;80: Thomas P, Williams T, Reilly PA, Bradley D. Modifying delivery technique of fenoterol from a metered dose. Ann Allergy 1984;52: Unzeitig JC, Richards W, Church JA. Administration of metered-dose s: comparison of open- and closed-mouth techniques in childhood asthmatics. Ann Allergy 1983;51: Chhabra SK. A comparison of closed and open mouth techniques of inhalation of a salbutamol metered-dose. J Asthma 1994;31: Cite this document as follows: Clinical Resource, Correct Use of Inhalers. Pharmacist s Letter/Prescriber s Letter. January Evidence and Recommendations You Can Trust 3120 West March Lane, Stockton, CA ~ TEL (209) ~ FAX (209) Subscribers to the Letter can get clinical resources, like this one, on any topic covered in any issue by going to PharmacistsLetter.com, PrescribersLetter.com, PharmacyTechniciansLetter.com, or NursesLetter.com

16 Video Instructions for Different Inhaler Devices Inhaler devices deliver medicine directly into the lungs. This is different from most pills or shots, which send medicine into the whole body. There are specific instructions for the various types of s. It s important for you to know how to correctly use the that s prescribed for you, so the medicine works best. Below are links to videos that show how to use different types of s. Your pharmacist or other health care professional can demonstrate correct use as well. Bring your (s) to the pharmacy or to appointments with your prescriber, so you can demonstrate how you use it, and get tips if you need help. Metered-dose s (e.g., Advair HFA, Aerospan, Alvesco, Atrovent HFA, Dulera, Flovent HFA, ProAir HFA, Proventil HFA, QVAR, Symbicort, Ventolin HFA, Xopenex HFA): Metered-dose (with spacer) Metered-dose (open mouth technique) Soft-mist (Combivent Respimat) Dry-powder s: Aerolizer (Foradil) Prepared for the subscribers of Pharmacist s Letter / Prescriber s Letter to give to their patients. Copyright 2014 by Therapeutic Research Center ~

17 Video Instructions for Different Inhaler Devices Diskus (e.g., Advair, Flovent, Serevent) Flexhaler (Pulmicort) HandiHaler (Spiriva) Neohaler (Arcapta) Pressair (Tudorza) Twisthaler (Asmanex) [January 2014] Prepared for the subscribers of Pharmacist s Letter / Prescriber s Letter to give to their patients. Copyright 2014 by Therapeutic Research Center ~

18 Instrucciones en Video Para Diferentes Inhaladores Los inhaladores envían medicamentos directamente a los pulmones. Esto es diferente de la mayoría de las píldoras o inyecciones, que envían medicamentos en todo el cuerpo. Es importante que usted use el inhalador correctamente, para que el medicamento funcione mejor. A continuación se presentan los enlaces a los vídeos que muestran cómo utilizar distintos tipos de inhaladores. Su farmacéutico u otro profesional de atención médica pueden demostrar el uso correcto. Llevar sus inhaladores a la farmacia o a las citas con su médico con el fin de demostrar cómo se utiliza, así como obtener sugerencias si necesita ayuda. Inhaladores de dosis prefijada (e.g., Advair HFA, Aerospan, Alvesco, Atrovent HFA, Dulera, Flovent HFA, ProAir HFA, Proventil HFA, QVAR, Symbicort, Ventolin HFA, Xopenex HFA): Inhaladores de dosis prefijada (con un espaciador) Inhaladores de dosis prefijada (técnica con la boca abierta) Inhalador de suave neblina (Combivent Respimat) Inhaladores de medicamento pulverizado: Aerolizer (Foradil) Prepared for the subscribers of Pharmacist s Letter / Prescriber s Letter to give to their patients. Copyright 2014 by Therapeutic Research Center ~

19 Instrucciones en Video Para Diferentes Inhaladores Diskus (e.g., Advair, Flovent, Serevent) Flexhaler (Pulmicort) HandiHaler (Spiriva) Neohaler (Arcapta) Pressair (Tudorza) Twisthaler (Asmanex) [Enero 2014] Prepared for the subscribers of Pharmacist s Letter / Prescriber s Letter to give to their patients. Copyright 2014 by Therapeutic Research Center ~

20 Tips for Correct Use of Inhalers Inhalers send medicine directly to your lungs. This is different from most pills or shots, which send medicine to the whole body. Instructions are not the same for all of the different types of s. Be sure you understand how to use each of your s. How can I learn to use my? Your pharmacist or prescriber can show you how to use your. Bring your s to the pharmacy or to prescriber appointments. You can show them how you use it. Then they can give you tips, in case you are having any problems. Ask your pharmacist or prescriber these questions: Do I need to shake my before using it? Do I need to prime my with test sprays? If so, how and when? Should I clean my? If so, with what (e.g., dry cloth, damp cloth, running water)? Are all s the same? No, they are not. See the differences between three common types of s. Have your health care provider fill in the names of the s you re using below. Metered-dose Inhalers: Dry-powder Inhalers: Soft-mist Inhalers: Shake most before use Do not shake Do not shake Prime before first use No need to prime Prime before first use Slow deep breath Quick deep breath Slow deep breath (Inhaler: ) (Inhaler: ) (Inhaler: ) What do I need to know if I use more than one? It is important to use your s in the right order. This will help them work better. Bronchodilators relax and open your airways. (Inhaler name: ) o Always use the bronchodilator first. Steroids decrease swelling in your airways. (Inhaler name: ) o After using your steroid, rinse your mouth with water and spit it out. Don t run out of your. Make sure you have enough medicine in your. o Most s have counters to keep track of how many doses are left. o If your does not have a counter, be sure to keep track of how many doses you have used. Don t remove s from original packaging until you need them. o Some expire a few weeks or months after removal from the foil pouch. o Your pharmacist will tell you the last date you should use these s. Don t wait until the last minute to reorder your. o Give yourself enough time so you don t go without these important medicines. How should I store my? Keep s at room temperature. If you are going out and may need your, keep it with you (on your person). Do not leave your in your car. It might get too hot or too cold. [This handout may not cover all possible information. It does not replace the need for professional medical care. Always follow the instructions from your healthcare provider.][december 2016; ] Prepared for the subscribers of Pharmacist s Letter / Prescriber s Letter to give to their patients. PharmacistsLetter.com ~ PrescribersLetter.com

21 Consejos para el uso correcto de los inhaladores Inhaladores mandan medicina directamente a sus pulmones. Esto es diferente de la mayoría de píldoras o inyecciones, en cual mandan medicina en todo el cuerpo. Instrucciones no son las mismas para todos los diferentes tipos de inhaladores. Asegúrese que comprenda como usar cada uno de sus inhaladores. Cómo puedo aprender cómo usar mi inhalador? Su farmacéutico o prescriptor podría ensenarle como usar su inhalador. Traiga sus inhaladores a la farmacia o citas con su prescriptor. Usted puede mostrarles como lo usa. Entonces ellos pueden darle consejos en caso que usted este teniendo problemas. Pregúntele a su farmacéutico o prescriptor estas preguntas: Necesito agitar mi inhalador antes de usarlo? Necesito cebar mi inhalador con aerosoles de prueba? Si es así, cómo y cuándo? Debería de limpiar mi inhalador? Si es así, con que (por ejemplo, tela seca, tela húmeda, agua corriente)? Todos los inhaladores son iguales? No, ellos no son. Mire las diferencias de tres tipos comunes de inhaladores. Haga que su profesional de atención de la salud escriba los nombres de sus inhaladores que usted este usando. Inhaladores de dosis fija: Inhaladores de polvo seco: Inhaladores de rocío fino: Agite la mayoría antes de usar No agite No agite Ceba antes del primer uso No ocupa cebar Ceba antes del primer uso Respiro profundo y despacio Respiro profundo y rápido Respiro profundo y despacio (Inhalador: ) (Inhalador: ) (Inhalador: ) Qué debo saber si uso más de un inhalador? Es importante de usar sus inhaladores en la orden correcta. Esto le ayudaran que funcionen mejor. Los broncodilatadores relajan y abren sus vías respiratorias (Nombre de inhalador: ) o Siempre use el broncodilatador primero. Los esteroides disminuyen la hinchazón en las vías respiratorias. (Nombre de inhalador: ) o Después de usar su inhalador de esteroides, enjuáguese la boca con agua y escúpalo. Que no se le acaban su inhalador. Asegúrese que tenga suficiente medicina en su inhalador. o La mayoría de los inhaladores tienen contadores para realizar un seguimiento de cuántas dosis quedan. o Si su inhalador no tiene un contador, asegúrese de mantener cuantas dosis has usado. No remueva los inhaladores de sus paquetes originales hasta que los ocupe. o Algunos expiran unas pocas semanas o meses después de la eliminación de la bolsa de aluminio. o Su farmacéutico le dirá el último día de cuándo deberá dejar de usar estos inhaladores. No espere hasta el último minuto para volver a ordenar su inhalador. o Dese suficiente tiempo para que usted no pase sin estas importantes medicinas. Prepared for the subscribers of the Letter to give to their patients. PharmacistsLetter.com ~ PrescribersLetter.com ~ NursesLetter.com

22 Consejos para el uso correcto de los inhaladores Cómo debo de guardar mi inhalador? Mantenga los inhaladores a temperatura ambiente. Si va a salir y podría necesitar su inhalador, manténgalo con usted (en usted). No deje su inhalador en su carro. Podría ponerse muy caliente o muy frio. [Este panfleto puede no tener toda la información posible. También no reemplaza la necesidad de atención médica profesional. Siempre siga las instrucciones de su profesional de atención de la salud.][diciembre 2016; ] Prepared for the subscribers of the Letter to give to their patients. PharmacistsLetter.com ~ PrescribersLetter.com ~ NursesLetter.com