Preventing Your Symptoms and Taking Your Medications Inhalation devices, proper technique and cleaning Knowing how to use your medications properly is important because inhaled drugs are meant to get directly into your airways to be effective. 5 Do you know how to properly use your inhalation devices? If your answer is no, you are not alone. Many people with COPD have trouble using their inhalers. 5 Using some kinds of inhalers involves a certain amount of practice and hand-eye coordination. So take careful note of what follows. If your answer is yes, it is time to review your knowledge and skills. Whatever your answer, be prepared. You will be asked to show your technique. Test your knowledge on inhalation devices You have to feel the medication when you inhale in order to be effective. The AeroChamber is a device that should not be used in public. The Nebulizer is more effective than dry powder inhalers, or metered-dose inhaler. true false true false true false Ask your physician or contact person to verify your inhalation techniques. Let them see how you do it! 32 Important: It takes the right technique to get an inhaled medication aerosol or powder into your airways. Do not hesitate to ask for your technique to be checked.
The devices that deliver your inhaled medications are classified in three categories: 5 1. The metered-dose inhaler (MDI) (with or without a spacing device) 2. The dry powder inhaler (DPI) 3. The nebulizer (compressor) Note: Several types of inhalation devices are available, but not all medications are available in each device. 5 Each type of inhaler will be described in more detail in the pages ahead. Important: Learning the right inhaler technique can be difficult, but you must persist. If you use any of these inhalers incorrectly, the medicine may not get into your airways as it is supposed to, and the therapy might fail. Handling these devices should become second nature to you, like a reflex. 33
Preventing Your Symptoms and Taking Your Medications The metered-dose inhaler (MDI) MDIs, also called inhalers or puffers, are the most common inhalation devices. 5 They are small enough to be carried in your pocket. You can use them with an open-mouth or closed-mouth technique depending on the type of medication and your skills. 5 It is recommended to hold your breath for up to 10 seconds (if possible) after inhaling the medication. 5 You need to be able to coordinate your inhalation with the activation of the inhaler. A spacing device can help if you are having difficulty. 5 MDIs can be used with the following bronchodilators: Advair 7, Atrovent 21, Berotec 9, Combivent 15, Flovent 18, Serevent 14, and Ventolin 12. Depress canister to activate inhaler. Atrovent Inhale medication. 34
Spacing devices What do you think a spacing device is used for? Spacing devices help the medication reach your lower airways. 5 Several models are available, but they work in a similar way. A spacing device should have a one-way valve, so it is also a holding chamber. This chamber holds a puff of your medication for a few seconds until you are ready to inhale it. This prevents drug loss caused by poor coordination between the actions of inhaling and of squeezing the canister. 5 Spacing devices can improve the effect of your medication. They can also decrease side effects such as bitter taste, hoarseness and thrush. 5 35
Preventing Your Symptoms and Taking Your Medications Example of a spacing device The AeroChamber MAX Valved Holding Chamber The AeroChamber is a valved holding chamber that will hold a puff of your medication until you are ready to breathe in. It is portable and can be used with most metered dose inhalers. 5 It is available with a mouthpiece or mask. 5 It can be useful for many people who use an inhaler and even during an attack. 5 Important: Spacers are sometimes covered by provincial health insurance programs or by private insurance companies. Ask your healthcare professional about this. 36
The dry powder inhaler (DPI) Dry Powder Inhalers deliver medication in a powder format. Not all medications are available in this form. They are small enough to be carried in your pocket or purse. Unlike the MDI, which is a press and breathe device, these inhalers are activated when you inhale. The dose of medication delivered depends on the force of your inspiration. 2 Because the powder is very fine, you may not feel anything when you inhale the medication. Pulmicort Turbuhaler Common DPI devices include: Diskus (Advair 21, Flovent 18 and Serevent 14 ), HandiHaler (Spiriva 8 ), and Turbuhaler (Bricanyl 10, Oxeze 13, Pulmicort 19 and Symbicort 22 ). 200 µ 37
Preventing Your Symptoms and Taking Your Medications The nebulizer This is a small machine which changes liquid medication into fine droplets which are inhaled through a mask. It is sometimes called a compressor, and is used by patients who have difficulty using an inhaler and/or spacer. It can be useful when you are taking high doses of medication. It is used in hospitals, especially in emergency rooms. 5 Nebulizers can be used with any medication that is available in liquid form. This includes: Atrovent 7, Combivent 15, and Ventolin 12. It can also be used with Pulmicort 19 Nebuamps. 38
What to remember on inhalation devices COPD drugs have to get into your lungs to work. You must use the appropriate device meaning the one that is most suitable for you. Become familiar with your medications, and take them as prescribed. Medications can make your life easier. Having the proper inhalation technique is important. Get your technique checked by your healthcare professional or your physician from time to time. 39