Health Professional Manual

Transcription

1 Health Professional Manual Session 4 COPD Medication and appropriate use of Inhaler Devices COPD medication Inhaler devices Metered dose inhaler (MDI) MDI with a spacing device Accuhaler Handihaler Turbohaler Respimat Inhaler Pulvinal Easyhaler Easi-breathe Autohaler Nebulisers Adapted from the Living Well with COPD program (2nd edition), Montreal Chest Institute, Canada

2 SESSION SUMMARY Education Plan and Methods Session Length: minutes Introduction Working Phase 1. Feedback from Learning Contract. Group Discussion 2. COPD Medication. Interactive lecturing. 2.1 Assessment of participants knowledge and beliefs with respect to COPD medication. Group discussion. 2.2 Presentation of the medication specific to COPD. Interactive lecturing 2.3 Medications used to treat a COPD exacerbation. Interactive lecturing 2.4 Additional medication used to manage COPD. Group discussion. 3. Inhaler devices for COPD medication. 3.1 Assessment of participants understanding with respect to inhaler devices. Group discussion. 3.2 Presentation of each inhaler device. Demonstration and practice. 4. Nebulisers for COPD medication. Group discussion and interactive lecturing. 5. Summary of the session and assessment of participants understanding and self-efficacy. Group discussion. Closing of the session Appendices section: Appendix 1: Additional information: 1. Should be Reinforcement of participants understanding and compliance with respect to COPD medication. 2. Reinforcement of participants proper use of inhalation devices. Human Resources 1. One health professional (recommended facilitator: nurse, pharmacist or physician) Living Well with COPD for Pulmonary Rehabilitation Resources 1. Information Booklet (Pages 10 to 24, and page 25 if any patients present in the session are on Oxygen) 2. Key messages: COPD Medications 3. Educational Posters: Normal Lung COPD Lung Medications (x3 posters) Inhaler devices (x10 posters) 4. Cue cards: Action Plan, Prevent your symptoms when exercising, Inhaler technique 5. COPD Action Plan Additional Resources 1. Board / Flipchart 2. Inhaler devices Prior to the session, ask participants to bring their own inhaler devices and Action Plans Bring placebo devices for demonstration purposes 3. Nebuliser device Environment 1. Use a quiet and comfortable room for 10 to 15 people. Ensure proper ventilation. 2. Place the chairs in a semi-circle around the board. 2

3 Introduction Presentation of the Facilitator. Outline the goals of this session. Review the key messages from the last session and link them to this session. Working Phase Educational Interventions 1. Feedback from learning contract 1.1 FEEDBACK FROM LEARNING CONTRACT Present this section using Group Discussion Use Attachment 1 (Cue Card: Action Plan) to support your teaching. Evaluate how participants managed to use the strategies from their Action Plan. Suggested script for the Facilitator: In the last session we looked at how your Action Plan plays an important part in your life, as it will help you make key decisions in treating COPD when your symptoms get worse. Suggested questions: Does anyone have any questions about their Action Plan? Provide the participants constructive feedback and reinforcement on their understanding of the directives of the Action Plan. Identify any participants having difficulty identifying their symptoms (baseline or exacerbation), understanding the Action Plan directives, getting their prescription, or any other patient that may require a one-to-one session with a member of the pulmonary rehabilitation team, their community respiratory team, practice nurse and/or doctor. 3

4 2. COPD Medication 2.1 ASSESSMENT OF PARTICIPANTS KNOWLEDGE AND BELIEFS WITH RESPECT TO COPD MEDICATION Present this section using Group Discussion Evaluate participants knowledge about COPD medication. Assess participants concerns that may affect compliance. Ask each of the participants and write the answers on the board. Suggested question: Which medications are used for the treatment of COPD (inhalers and pills)? Which COPD medication must be used in case of emergency? Do you know how COPD medications act inside the lungs? Do you believe that the medication you take for COPD is effective? Do you believe that it is necessary to take your COPD medication regularly? What are the concerns you have in regards to the medications you take for your COPD? 2.2 PRESENTATION OF THE MEDICATION SPECIFIC TO COPD TREATMENT Present this section in an Interactive Way Use the posters Normal Lung, COPD Lung and Medications and Attachment 2 (Cue Card: Prevent your symptoms when exercising) to support your teaching. Present to participants the role of each of the 3 groups of medication used in COPD treatment: Bronchodilators, Corticosteroids and Combination of long-acting bronchodilator and corticosteroid. Suggested script for the Facilitator: During the last education session, you recorded on your Action Plan the medications you use everyday to control your COPD symptoms. There are three main types of medications that are used everyday by patients with COPD: bronchodilators, corticosteroids, and combination bronchodilator and corticosteroids. I will talk about each of these in turn and then help you identify which of these medications you have been prescribed. 4

5 Bronchodilators: They work by opening up the airways to allow for easier breathing. They relieve the symptom of shortness of breath. Because they work for different lengths of time, they are usually called shortacting or long-acting bronchodilators. Short-acting bronchodilators start to work within 5 minutes, therefore are ideal as reliever medications because they bring quick relief to shortness of breath (Attachment 2). Long-acting bronchodilators take up to 20 minutes to work but their effects last for longer, therefore they work for 12 hours or 24 hours to keep your airways open. They may be taken in either of 2 ways: inhaled, favoured since they work directly on the lungs, have fewer side effects and can be combined with other medications; or oral, less desired since there are more side effects and they are more difficult to combine with other medications. Note to the facilitator: Remember to link this session to the participants action plans by identifying the short-acting and long-acting bronchodilators that the participants have been prescribed. Additional notes relative to anticholinergics (short- or long-acting): Anticholinergic drugs may potentially worsen symptoms and signs associated with narrow-angle glaucoma. Care must be taken not to allow the drug to be in contact with the eyes. This includes the following precautions: for spray inhalers (for example, MDI, Respimat), always use closed-mouth inhaling techniques and direct the inhaler away from the face when priming it; avoid touching Spiriva capsules when discarding them, and wash hands if this occurs; make sure nebuliser mask fits properly and there are no leaks. Have at hand a list of names of common medications that contain anticholinergics. 5

6 Corticosteroids Corticosteroids also known as anti-inflammatories reduce certain types of inflammation in your airways. Corticosteroids come in two forms 1. Inhaled 2. Oral Inhaled corticosteroids reduce the inflammation and swelling in your airways. They are mainly helpful for COPD patients with frequent exacerbations. Oral corticosteroids can help to treat exacerbations (which we will talk about shortly). They do not provide quick relief of symptoms and should not be used as reliever medication. They are not the type of steroid that is sometimes taken illegally by athletes. Note to the facilitator: Remember to link this session to the participants action plans by identifying the corticosteroid inhalers that the participants have been prescribed. Additional notes relative to inhaled corticosteroids: Remind participants to rinse their mouth with water (and do not swallow) after inhaling any medication containing corticosteroids (alone or in combination). This is very important to avoid fungal infections in the mouth. Have at hand a list of names of common medications that contain inhaled corticosteroids Combination Long-acting Bronchodilator + Inhaled Corticosteroid These inhaled medications combine the properties of a long-acting bronchodilator (to open up airways) and a corticosteroid (to reduce inflammation and swelling). These medications are helpful for COPD patients with frequent exacerbations. These medications can also be helpful for some patients to further relieve symptoms. They do not provide quick relief of symptoms so they should not be used as reliever medication. 6

7 Note to the facilitator: Remember to link this session to the participants action plans by identifying the combination bronchodilator and corticosteroid inhalers that the participants have been prescribed. Inform participants that if they feel their medications are not controlling their symptoms then they should speak to a member of the pulmonary rehabilitation team, their GP or their Practice Nurse. Inform participants that they should make sure that their Action Plan is updated every time their medications have been changed. Additional notes relative to inhaled corticosteroids: Remind participants to rinse their mouth with water (and do not swallow) after inhaling any medication containing corticosteroids (alone or in combination). This is very important to avoid fungal infections in the mouth. Have at hand a list of names of common medications that contain inhaled corticosteroids. 2.3 MEDICATIONS USED TO TREAT A COPD EXACERBATION Present this section in an Interactive Way Use the posters Medications to support your teaching. Present to participants the role of oral corticosteroids and antibiotics to treat a COPD exacerbation Suggested script for the facilitator: During an exacerbation you may be prescribed additional medications such as oral corticosteroids and antibiotics. 7

8 Oral Corticosteroids Antibiotics Oral corticosteroids are usually prescribed for short periods (1-2 weeks). They are rarely prescribed on a permanent basis. They can relieve symptoms such as shortness of breath, cough and sputum. These medications usually come as tablets. They are used for treating exacerbations caused by a chest infection such as sinusitis, infected bronchitis, pneumonia, etc. They can relieve respiratory symptoms related to infections such as fever, worsening of cough or sputum. There are many different types of antibiotics, but a doctor can recommend which one is best for each patient. The antibiotic treatment must be taken completely, even if there are signs of improvement. Note to the facilitator: Inform the participants that some medications may interact or may not be suitable for use in every patient. They need to be aware of this and if they have any queries they should discuss this with their doctor. Additional notes relative to side effects and/or allergies: Some medications are associated with allergies. Advise participants that if they experience any side-effects and/ or allergies they should discuss these with their doctor as these may be associated with their medications. Inform the participants that common side effects of the medications covered in this session are summarised in their information booklets (Pages 10 to 13). Some presentations (medication and inhaler) should not be prescribed to patients with allergy to milk proteins. For example: Seretide Accuhaler, Serevent Accuhaler, Spiriva Handihaler, Oxis Turbohaler, Symbicort Turbohaler. These presentations (medication and inhaler) contain lactose which may be contaminated with milk proteins. A milk protein allergy (or milk allergy) is not the same as lactose intolerance (or milk intolerance). 8

9 2.4 ADDITIONAL MEDICATIONS USED TO MANAGE COPD Present this section using Group Discussiony Discuss with the participants any additional medications they have been prescribed to manage their COPD and have included on their Action Plan. Suggested question: Have you included any other medications on your Action Plan? Suggested script for the facilitator: Oxygen: Some people with COPD may need Oxygen if they have been admitted to hospital with an exacerbation. Other people may need Oxygen on a long-term basis. Note to the facilitator: Identify participants who may need additional information on oxygen therapy, for example participants who are on long-term oxygen therapy. They may require an additional education session. This should be arranged for a later date. Inform participants that information on long-term oxygen therapy can be found in their information booklet on page 25. 9

10 3. Inhaler devices for COPD medication Evaluate participants understanding about inhaler devices. Assess participants concerns that may affect the use of inhaler devices. Ask each of the participants and write the answers on the board. Suggested questions: 3.1 ASSESSMENT OF PARTICIPANTS UNDERSTANDING WITH RESPECT TO INHALER DEVICES Present this section using Group Discussion Which inhaler devices are you using? Can you please show them to me? Do you find it difficult to use inhaler devices? Which one and why? 3.2 PRESENTATION OF THE ADVANTAGES, DISADVANTAGES AND INHALATION TECHNIQUES OF EACH INHALER Life Experiences Demonstration and Practice Use placebo inhaler devices to support your teaching. If placebo inhaler devices are not available use the posters Inhaler Devices to support your teaching. Present each inhaler device individually, in the following order: 1. Describe its advantages and disadvantages. 2. Demonstrate the inhalation technique and have participants practice in front of you. Correct them as needed and reinforce proper use of the technique. 3. Provide additional comments. Note to the facilitator: Only present the inhaler devices and spacers that the participants use. Start with the one that is most commonly used. If participants use any other inhalers or spacers that have not been covered by the LWWCOPD programme for pulmonary rehabilitation, present and discuss these also. Suggested script for the facilitator: So you ve brought with you today some of the most common inhalers used with COPD medication. Let s look at each one in turn. 10

11 METERED DOSE INHALER (MDI) OR INHALATION AEROSOL The inhalation aerosol delivers the medication directly to your lungs. When you press on the canister, one exact dose of medication is released. Advantages and Disadvantages Small enough to be carried in your pocket. You need to be able to coordinate your breath in with the activation of the inhaler. A spacing device can help if you are having difficulty. Steps to follow 1. Remove the cap. 2. Shake the device 3-4 times up and down (to mix the contents well). 3. Tilt your head slightly back and breathe out normally. 4. Place the mouthpiece carefully between your teeth and seal your lips around it. 5. Begin breathing in slowly through your mouth. Press down once on the canister and continue breathing in slowly (only once to release one dose of medication). 6. Continue to breathe in slowly and deeply until your lungs are full. 7. Hold your breath for 4-10 seconds, so the medication will have time to settle in your airways. 8. If another dose is required, wait one minute between puffs and repeat steps Replace the protective cap. MDI WITH SPACER Advantages and Disadvantages A spacing device improves the deposition of medication in the lower airways. It requires less coordination. It reduces side effects such as fungal infections of the mouth and throat. The spacer devices are bigger than the MDI alone, and some patients will find them embarrassing to use in public or cumbersome to carry. Steps to follow 1. Remove the caps. 2. Shake the inhaler 3-4 times and connect it to the spacing device, keeping the inhaler upright. 3. Tilt your head slightly back and breathe out normally. 4. Place the spacing device mouthpiece carefully between your teeth and seal your lips around it. 5. Press canister once. 11

12 Comments 6. Breathe in slowly and deeply through your mouth. 7. a) Single breath technique: Try to hold your breath for 4-10 seconds. Then breathe out normally. b) Tidal volume technique: If you find it difficult to take one deep breath or to hold your breath for long, breathe slowly in and out of the spacer device, 3-4 times in a row. 8. If you need more than one dose, wait 30 seconds to 1 minute between puffs and repeat steps Replace the protective caps. There are several spacer devices available. The most common include the Volumatic and the Aerochamber. As you breathe in and out through the Volumatic when using the tidal volume technique, the Volumatic will make a clicking sound. This indicates that you are using a good breathing pattern. When using the Aerochamber, if the breath in is too fast, you will hear a musical sound, indicating that you should slow down your breathing, otherwise the medication will remain in the throat more than in the lungs. A spacer may be useful to deliver medications during an exacerbation when you are so short of breath that you are unable to use the correct technique for your MDI. ACCUHALER Accuhaler is a breath-activated inhaler. This means that the medication is released by the effort you make when breathing in. Advantages and Disadvantages There is a dose counter so patients can know exactly how many doses are left. It contains lactose, so the sweet taste will tell you if you have taken your dose properly. Although for some patients this could be a disadvantage if they do not like the taste. This inhaler does not need a lot of coordination. Small enough to be carried in your pocket. Steps to follow 1. Hold the outer case in one hand and put the thumb of the other hand on the thumb grip. Push the thumb away as far as it will go until a click is heard. 2. Slide the lever away as far as it will go until a click is heard. 3. Hold the Accuhaler away from the mouth and breathe out completely. 12

13 4. Place the mouthpiece carefully between your teeth, seal your lips around it and breathe in quickly and deeply through the Accuhaler. Remove the Accuhaler, hold your breath for about 4-10 seconds, then breathe out slowly. 5. Close your Accuhaler by sliding the thumb grip back as far as it will go until a click is heard. 6. If you need more than one dose repeat steps 1-4. HANDIHALER Handihaler is a breath-activated inhaler. This means that the medication is released by the effort you make when breathing in. Advantages and Disadvantages This inhaler is easy to use, no coordination is necessary. You only have to use it once a day. Steps to follow Comments 1. Open the dust cap by pulling it upwards. 2. Open the mouthpiece. 3. Remove a Spiriva capsule from the blister (only immediately before use) and place it in the centre chamber. 4. Close the mouthpiece firmly until you hear a click. 5. Hold the HandiHaler with the mouthpiece upwards and press the green button completely in once, and release. 6. Hold the HandiHaler far away from your mouth and breathe out normally. 7. Place the mouthpiece carefully between your teeth and seal your lips around it. Breathe in slowly and deeply to hear the capsule vibrate. 8. Remove the HandiHaler while holding your breath for 4-10 seconds, then breathe out normally. 9. You can breathe in again to ensure that you have taken all the medication. 10. Open the mouthpiece again. Tip out the used capsule and dispose (avoid touching the capsule; if you do, do not touch your eyes and be sure to wash your hands properly). 11. Close the mouthpiece and dust cap for storage. The capsules are sensitive to light and humidity, therefore only open the aluminium cover immediately before use, and be careful in order to not to expose more than one capsule each time. 13

14 TURBOHALER Turbohaler is a breath-activated inhaler. This means that the medication is released by the effort you make when breathing. Advantages and Disadvantages This inhaler does not need a lot of coordination. The Turbuhaler is activated by breathing in as deep and as hard as you can through your mouth. A minimum inspiratory flow rate is needed in order for the medication to be delivered effectively into the lungs. The patient may be unable to feel, smell or taste the medication when breathing it in. Small enough to be carried in your pocket. The Turbohaler must be protected against humidity, since the powder within the container could clump. Steps to follow Comments 1. Unscrew plastic cover. 2. Hold the Turbohaler upright. 3. To load the inhaler with a dose turn the grip as far as it will go in one direction and then turn it back again as far as it will go in the opposite direction. You will hear a click some time during this procedure. 4. Hold the Turbohaler far away from your mouth and breathe out normally. 5. Place the mouthpiece carefully between your teeth and seal your lips around it. Breathe in deeply and forcefully through your mouth. 6. Remove the Turbohaler from your mouth and hold your breath for 4-10 seconds. 7. If another dose is required, repeat steps Put the protective cap back on. The device has a dose counter that can be seen through a small window below the mouthpiece indicating the amount of doses remaining. When the red mark appears, the device is almost empty. Do not shake the Turbohaler (it is not necessary and this will waste the dose if charged). The rattle that can be heard when the device is shaken is not the medication, but a desiccant (agent to absorb the humidity that could damage the Turbohaler ) and it is not an indication of the amount of medication still available inside the device. 14

15 RESPIMAT Advantages and Disadvantages The Spiriva Respimat contains 60 doses. When the pointer enters the red area there are enough doses for approximately 7 days. You should order a new prescription from your GP. Once the dose indicator has reached the end of the red scale, there are no doses left and the Spiriva Respimat locks. It can no longer be used. Steps to follow 1. Hold the Spiriva Respimat upright with the cap closed. Turn the clear base until it clicks. Open the plastic cap. 2. Breathe out slowly and holding the Spiriva Respimat level, place the mouthpiece carefully between your teeth. Seal your lips around the mouthpiece without covering the air vents. 3. While taking in a slow, deep breath, press the dose release button and continue to breathe in slowly. 4. Remove the Spiriva Respimat from your mouth and hold your breath for about 10 seconds. 5. Replace the plastic cap. Comments Before using the Spiriva Respimat for the first time it needs to be prepared. Please refer to the manufacturer s instructions for guidance on preparing the Spiriva Respimat for use or ask a member of the pulmonary rehabilitation team for guidance. Do not take the inhaler apart, or remove the transparent base, once the cartridge has been inserted. If your Spiriva Respimat has not been used for more than 7 days release one puff towards the ground. 15

16 PULVINAL Advantages and Disadvantages Easy to use, no coordination is necessary. If you taste a slightly sweet powder in your mouth after breathing in through the Pulvinal you have received the dose Steps to follow 1. Unscrew the protective cap. 2. Hold the Pulvinal upright and tap it gently against a hard surface, to level the powder in the container. 3. Hold the Pulvinal upright. Press the button on the mouthpiece with one hand and rotate the inhaler body anti-clockwise with the other hand until it clicks. You should see a red mark through the hole in the mouthpiece. This is the loading position. 4. Keep holding the Pulvinal upright. Rotate the inhaler body clockwise until it clicks again and a green mark shows through the hole in the mouthpiece. This is the dose-delivery position. 5. Breathe out deeply. Do not breathe out through the Pulvinal. 6. Place the mouthpiece carefully between your teeth and seal your lips around it, while holding the Pulvinal upright. Breathe in through your mouth as quickly and as deeply as possible. 7. Hold your breath for 10 seconds. 8. Remove the Pulvinal from your mouth. 9. If another dose is required, repeat steps Replace the protective cap. Comments A red ring will appear at the bottom of the container when the inhaler needs to be replaced. If you continue to use your inhaler after the red ring appears you may not get the correct dose that has been prescribed for you. Must be kept in a dry place at room temperature. Do not remove the protective cap until the moment of use. 16

17 EASYHALER Advantages and Disadvantages Easy to use, no coordination is necessary. Steps to follow Comments 1. Remove the dustcap. 2. Shake the Easyhaler 3 to 5 times, then hold it upright. 3. Release the dose by pressing the device between thumb and forefinger just once, until you hear a click. 4. To inhale your drug dose, first breathe out normally. Then place the mouthpiece carefully between your teeth and seal your lips around it. Take a strong, deep breath. Hold your breath for 5 to 10 seconds. 5. If you need more than one dose repeat steps Replace the dustcap after use. The inhaler has a dose counter that shows the number of remaining doses. The counter turns after every 5 doses. When the counter turns red there are 20 doses left. Now s the time to get your prescription renewed. It is recommended that you keep your Easyhaler in its protective cover. If your Easyhaler gets damp you will need to replace it with a new one. If you think that you clicked the Easyhaler more than once, remove the dose from the mouthpiece by tapping it against the palm of your hand or, for example, a table and start again. EASI-BREATHE Easi-breathe is a breath-operated inhaler. This means it only releases a dose when you breathe in. Advantages and Disadvantages Easy to use, no coordination is necessary. Steps to follow 1. Shake the Easi-breathe vigorously. 2. Hold the Easi-breathe upright and open it by folding down the cap which fits over the mouthpiece. 3. Breathe out normally as far as you comfortably can. 17

18 Comments 4. Place the mouthpiece carefully between your teeth and seal your lips around it. 5. Hold the Easi-breathe upright and make sure that your hand is not blocking the airholes. 6. Breathe in slowly and deeply through the mouthpiece. Don t stop breathing when the inhaler puffs the dose into your mouth. Carry on until you have taken a deep breath. 7. Take the Easi-breathe out of your mouth and hold your breath for 10 seconds or for as long as you comfortably can. Then breathe out slowly. 8. After you have used your inhaler, hold it upright and close the cap immediately. 9. If you need to take more than one puff wait about one minute and repeat steps 1-8. Test spray the inhaler by firing two shots into the air before you use it for the first time or if you have not used it for five days or more. To test spray your inhaler, unscrew the top of it so you can see the metal can inside. Open the cap, shake the inhaler and spray the aerosol by pressing the can with your finger or thumb. Close the cap and put the top back on. It is important when using this medicine to hold the inhaler upright as it will not work if it is not held in this position. AUTOHALER Autohaler is a breath-activated inhaler, which means that the medication is released when you breathe in. Advantages and Disadvantages Does not require co-ordination. When you breathe in through the Autohaler you will hear a click and feel mist when your breath activates the medication. Steps to follow 1. Remove the cap from the Autohaler. 2. Shake the Autohaler. 3. Hold the Autohaler upright. 4. Push the lever up so that it stays up. 5. Keep holding the Autohaler upright, making sure that your hand is not blocking the air vent at the bottom. 18

19 6. Breathe out as far as you comfortably can and immediately place the mouthpiece carefully between your teeth and seal your lips around it. 7. Breathe in slowly and deeply through the mouthpiece. Do not stop breathing in when you hear the click and feel the mist in your mouth. It is important that you keep breathing in after the puff is released. 8. Hold your breath for 10 seconds and then breathe out slowly. 9. Return the lever to the down position while keeping the Autohaler upright. 10. If another dose is required, repeat steps Replace the protective cap. Comments The medicine will only be released from the Autohaler if you push the lever up first. This gets the dose ready so that it will be released when you breathe in through the inhaler. Note to the facilitator: Emphasise to participants the importance of taking their prescribed medication regularly. Correct inhalation technique is vital to prevent and control symptoms (shortness of breath, wheezing, etc). Emphasise to participants the importance of regularly cleaning and maintaining their inhalers and spacers. Refer them to the manufacturers instructions included with each device and also to their information booklet (Pages 14 to 23). 19

20 4. Nebulisers for COPD medication 4.1 ASSESSMENT OF PARTICIPANTS UNDERSTANDING WITH RESPECT TO NEBULISERS Present this section using Group Discussion Evaluate participants understanding about nebulisers. Suggested questions: Does anyone use a nebuliser? What is a nebuliser? Why do you use it? 4.2 PRESENTATION OF THE USE OF NEBULISERS FOR COPD MEDICATION Present this section in an Interactive Way Use a nebuliser device to support your teaching. Suggested script for the Facilitator: A nebuliser is used by patients who have difficulty using an inhaler and/or spacer. Most people with COPD do not need a nebuliser. The nebuliser chamber holds the liquid medication. The compressor is the machine that provides the pressure to produce fine droplets from the liquid medication. The fine droplets are breathed in through a mouthpiece or mask. It can be useful when you are taking high doses of medication. It is used in hospitals, especially in Accident and Emergency. Nebulisers can be used with any medication that is available in liquid form. You should only use a nebuliser if your doctor has advised you to. Note to the facilitator: Emphasise to participants the importance of regularly cleaning and maintaining their nebulisers. Ask them to get a member of the community respiratory team to help them practice how to set up and use their nebuliser. Also refer them to the manufacturer s instructions. 20

21 5. Summary of the session and assessment of participants understanding and self-efficacy 5.1 SUMMARY OF THE SESSION AND ASSESSMENT OF PARTICIPANTS UNDERSTANDING AND SELF-EFFICACY Present this section using Group Discussion Evaluate participants understanding and self-efficacy to comply with COPD medication by taking it as prescribed on a regular basis and using the proper technique. Use this opportunity to summarise the key messages from the session. Use Attachment 3 (Key messages: COPD Medications) to support your teaching. Suggested questions: How confident are you that you know why you use your COPD medication? How confident are you that you know how to use your COPD medication? How confident are you that you can use your medications as prescribed, without forgetting doses? Suggested script for the Facilitator: Take your medications regularly and as prescribed in order to manage and control your symptoms. Using your inhalers with the proper technique is very important to get the maximum benefit. Ask a member of the pulmonary rehabilitation team, your GP or your Practice Nurse to review your technique on a regular basis. If you feel your medications are not controlling your symptoms, speak to a member of the pulmonary rehabilitation team, your GP or your Practice Nurse. Make sure that your Action Plan is updated every time your medications have been changed. Note to the facilitator: Remind participants to ask their GP and/or Practice Nurse to review their inhaler techniques at each follow-up visit. Inform participants that the key messages from this session are summarised on their key messages sheet (attachment 3) and the inhaler techniques are summarised in their information booklets (Pages 14 to 23). 21

22 If participants feel confident complying with their COPD medication by taking it as prescribed, on a regular basis and using the proper technique, ask them to continue applying the strategies suggested in this session. If some participants do not feel confident, ask them to speak to a member of the pulmonary rehabilitation team on an individual basis to investigate the reasons and reinforce the compliance with medication and the proper use of inhalation techniques. Closing the session Answer the questions of the participants. Learning contract: Encourage the participants to ask their doctor and/or practice nurse, at each visit, to check their inhaler technique and also how they set up and use their nebuliser (Attachment 4: Cue card: Inhaler technique). CONTRACT Evaluate the satisfaction of the participants with regards to the present session. 22

23 ATTACHMENTS Attachment 1: Action Plan Would you like to discuss your Action Plan today? Ask a member of the pulmonary rehabilitation team. 23

24 ATTACHMENTS Attachment 2: Prevent your symptoms when exercising If you become wheezy or very short of breath when doing your exercises, remember to take your short-acting bronchodilator (reliever) before the class. 24

25 ATTACHMENTS Attachment 3: COPD Medications Key Messages Take your medications regularly and as prescribed in order to manage and control your symptoms. Using your inhalers with the proper technique is very important to get the maximum benefit. Ask a member of the pulmonary rehabilitation team, your GP or your Practice Nurse to review your technique on a regular basis. If you feel your medications are not controlling your symptoms, speak to a member of the pulmonary rehabilitation team, your GP or your Practice Nurse. Make sure that your Action Plan is updated every time your medications have been changed. 25

26 ATTACHMENTS Attachment 4: Inhaler technique Would you like your inhaler technique checked today? Ask a member of the pulmonary rehabilitation team. 26

27 APPENDICES SECTION Appendix 1: 1. Reinforcement of understanding and compliance to medication 1.1 REINFORCEMENT OF PARTICIPANTS UNDERSTANDING AND COMPLIANCE WITH RESPECT TO COPD MEDICATION Evaluate and reinforce participants understanding and compliance with respect to COPD medication. Invite patients to ask questions. Have each patient respond at least one of the questions. Write the answers on the board. Suggested questions to foster discussion: Present this section in an Interactive Way What is the use of a bronchodilator? What is the use of an anti-inflammatory? Which medication should you use in case of emergency? Antibiotics and Prednisone are helpful to treat? Why is it important to take your COPD medication regularly and as prescribed? What could help you to take your medication regularly? 27

28 APPENDICES SECTION 2. Reinforcement of participants proper use of inhalation devices 2.2 REINFORCEMENT OF PARTICIPANTS PROPER USE OF INHALATION DEVICES. Present this section in an Interactive Way Evaluate participants understanding with respect to inhalation devices. Reinforce the importance of taking medication as prescribed and using the proper technique. Invite patients to ask questions. Write the answers on the board. Suggested questions: What are the benefits of using your inhalation devices correctly? What are the advantages of using a spacing device with your inhalation aerosol? What can you do to use properly your inhalation devices? Explain to participants the importance to verify the techniques for the use of the various inhalation devices at each follow-up visit to their clinic or home visit. Support your explanation on scientific data Suggested script for facilitator: Studies have demonstrated that more than 75 % of the patients have difficulties using metered-dose inhalers. 1, 2 38 % of the patients do not keep an adequate technique over time. 3, 4 Remember the importance of taking regularly the prescribed medication. A proper use of the different devices is vital to prevent and control the symptoms (shortness of breath, wheezing, etc.). 1 Goodman DE, Isreal E, Rosenberg M, et al. The influence of age, diagnosis and gender on proper use of metered-dose inhalers. Am J Respir Crit Care Med 1994;150: Van Beerendonk I, Mesters I, Mudde AN, Tan TD. Assessment of the inhalation technique in outpatients with asthma or COPD using a metered-dose inhaler or dry powder device. J Asthma 1998;35: De Blaquiere P, Christensen DB, Carter WB, Martin TR. Use and misuse of metered-dose inhalers by patients with chronic lung disease. Am Rev Respir Dis 1989;140: Cromptom GK. The adult patient s difficulties with inhalers. Lung 1990; Suppl 168: Remind participants to ask their resource person to review their inhalation techniques at each follow-up visit. 28

29 NOTES 29

30 ACKNOWLEDGEMENTS Living Well with COPD was developed in coordination with health professional educators on COPD and patients with COPD. Adaptation from the Living Well with COPD program (2nd edition), Montreal Chest Institute, Canada for Pulmonary Rehabilitation Programmes in Northern Ireland December 2011 Authors: Northern Ireland: B. O Neill, PhD, BSc, MCSP D. Cosgrove, PhD, BSc, MCSP J. MacMahon, FRCP J. M. Bradley, PhD, BSc, MCSP Canada: M. Lebel, RN, BSc M. Sedeno, BEng, MM D. Nault, RN, MSc J. Bourbeau, MD, MSc, FRCPC Participating Institutions University of Ulster, Northern Ireland Belfast Health and Social Care Trust, Northern Ireland Montreal Chest Institute, McGill University Health Center, Canada The Living Well with COPD programme for pulmonary rehabilitation has been endorsed by: The Association of Chartered Physiotherapists in Respiratory Care The Northern Ireland Regional Respiratory Forum Original Authors (Montréal, Québec, Canada, 2006) D. Nault, RN, MSc M. Sedeno, BEng, MM D. Paul-Émile, RRT M. Paquette, RRT J. Bourbeau, MD, MSc, FRCPC Participating Institution Montreal Chest Institute, McGill University Health Center, Canada Public Health Agency Belfast Health and Social Care Trust