Instructions for using inhalers in the treatment of respiratory diseases

This is an automatically translated article.

The article was professionally consulted with MSc.BS Nguyen Huy Nhat - Department of Medical Examination & Internal Medicine - Vinmec Danang International General Hospital.
There are many types of inhalers in the treatment of respiratory diseases and each type has an inhaler device corresponding to the dosage form. In principle, if you know how to use it and perform it under ideal conditions, all drugs give maximum effect. However, in reality this is not possible. Therefore, patients need to understand the instructions for using inhalers in the treatment of respiratory diseases to achieve the highest therapeutic effect.

1.How to use metered dose inhaler

Metered Dose Asthma Inhalers (MDI) is an instrument used to deliver a wide range of inhaled medications in a predetermined amount per dose.
An MDI metered dose inhaler has a structure consisting of a pressure canister, a pressure measuring valve, a vial body, and an outflow dispenser. This is considered the simplest and most convenient device, the most portable of all asthma inhalers.
However, to promote optimal effectiveness, patients need to know how and perform well the spray technique, helping the medicine to spread evenly and deeply into the airway system.
The general rule of thumb for using the MDI metered dose inhaler for the first time is to have the inhaler ready:
Shake the vial well for five seconds. Place the vial into the MDI metered dose inhaler by pressing the bottom of the vial down with your index finger. Keep away from face to avoid getting medicine into eyes. Press the vial down three more times to get it ready to use. After using the inhaler for the first time, there is no need to re-prime unless the vial or the MDI metered dose inhaler has not been used for two weeks or more. Instructions for using the metered dose inhaler after you have prepared the inhaler for all subsequent times are the same:
Remove the cap of the mouthpiece and check to ensure ventilation, no foreign objects in loose objects in the inhaler MDI dose metering Shake the MDI metered dose inhaler vigorously for approximately five seconds Hold the MDI metered dose inhaler upright with your index finger resting on the bottom of the vial and your thumb supporting the bottom of the MDI metering inhaler Exhale normally through the mouth Place the mouthpiece between your teeth and close your lips around the mouthpiece. The position of the tongue in the mouth does not block the mouthpiece opening of the metered dose inhaler Press your index finger to the bottom of the vial to release the medication and at the same time take a slow, deep breath through the mouth until the lungs are filled. completely, it may take three to five seconds Hold your breath to hold the medicine in your lungs for about 5 to 10 seconds before exhaling. Finish by removing the metered dose inhaler from your mouth and closing the mouthpiece

If a second blow is needed, wait about 15 to 30 seconds between strokes. Repeat from strong step of MDI metered dose inhaler one more time before injecting next puff.
If using a metered dose inhaler with steroids, rinse your mouth with clean water after inhalation to remove excess medication deposited in the mouth and throat. After that, the water must be spit out, not swallowed.
For children, using a metered dose inhaler with a spacer, also known as a babyhaler, follows the same sequence as above and adds the step of attaching the metered dose inhalers to the spacer. .
At the same time, if a mask attached to the spacer is used, the mask must be placed to ensure a tight fit and completely cover the child's nose and mouth. Even a small leak can significantly reduce the amount of medicine reaching the lungs, and a soft inflatable mask will better fit a child's face than a hard or over-inflated mask. One spacer can be used for more than one drug by removing the first MDI metered dose inhaler and inserting another.
However, do not load both puffs into the chamber and then ask the child to empty the spacer with just one inhalation. Finally, parents also need to pay attention to cleaning the spacer, the mask after letting the child inhale the medicine.

2. How to use a dry powder inhaler

A dry powder inhaler is a powder inhaler that is also pre-dose similar to metered-dose inhalers. However, the difference is that the force generated to help push the drug into the airways is thanks to the force of inhalation of the lungs instead of pressing the vial like with metered dose inhalers.
Therefore, using a dry powder inhaler has the advantage that it does not require consistent coordination between the hand pressing and the inhaler mouth. However, the user of the dry powder inhaler must ensure good inhalation ability, ensuring the drug goes deep and the airways. Therefore, dry powder inhalers will not be suitable for use by the elderly, weak, children under 8 years old or in acute difficulty breathing due to respiratory disease.
Even so, the effectiveness of a dry powder inhaler is still highly dependent on how it is used. Before using a new dry powder inhaler for the first time, prepare the following:
Remove the cap of the dry powder inhaler. Hold the bottle in the palm of your hand and with the other hand rotate the dosing pin in one direction and again in the opposite direction. Close the cap and the dry powder inhaler is ready to use at any time. To inhale the dry powder inhaler after preparing it for each use, follow the instructions below:
Remove the cap of the dry powder inhaler. Hold the bottle in the palm of your hand and with the other hand rotate the dosing pin in one direction and again in the opposite direction. Keep the dry powder inhaler away from your mouth. Exhale as gently and comfortably as possible. Place the mouthpiece of the dry powder inhaler between your teeth, close your lips. Breathe in as deeply and as hard as you can through your mouth. Do not chew or bite into the mouthpiece. Remove the dry powder inhaler from your mouth and exhale gently. If a second inhalation is required, repeat the above procedure from the loading step. Finish by closing the lid tightly after use. If using a dry powder inhaler with steroid medicine, rinse your mouth with clean water after inhalation to remove excess medication deposited in the mouth and throat. After that, the water must be spit out, not swallowed.
Do not attempt to unscrew or twist the dry powder inhaler, as the medication container and inhaler are built into one unit. Therefore, do not use if the tool is damaged or detached.
Some dry powder inhalers have a dose indicator, allowing the number of doses remaining in the tube to be identified. If accidentally refilled more than once before inhalation, the amount inhaled is equivalent to only one dose, but the dose indicator is reduced.

3. How to use a fine particle inhaler

A fine-particle inhaler is also a liquid inhaler and is pre-metered in the same way as metered-dose inhalers or dry powder inhalers. However, the difference is that the fine-particle inhaler both does not require a propellant like metered-dose inhalers and does not require suction to take the medicine like a dry powder inhaler. With this device, a certain amount of the drug according to the dose is released from the liquid form to the outside in the form of a mist. Accordingly, the patient has a prolonged inhalation time, creating conditions for the drug to go deep into the airways.

The presentation of drugs used with the fine-particle inhaler is usually disassembled with the device. Therefore, similar to metered-dose inhalers, it is necessary to prepare the inhaler before first use:
Open the vial cap of the fine-particle inhaler. Push the tip of the vial into the medication portion of the inhaler as far as possible. Place the inhaler upright on a hard surface and press firmly on the bottom of the vial to ensure that the vial has reached the full length of the inhaler. Close the lid of the potion holder. Hold the inhaler upright with the lid closed and rotate the stand in the direction of the arrow on the label to load the dose. Open the inhaler cap. Point the inhaler down and press the dose release button. Close the inhaler cap and repeat the refill, releasing the dose 2 more times. Close the inhaler cap and the fine-particle inhaler is ready to use at any time. Once the fine particle inhaler is prepared, subsequent inhalations are performed as follows:
Hold the fine particulate inhaler upright with the inhaler cap still closed. Rotate the stand in the direction of the arrow on the label to load the dose. Open the inhaler cap. Exhale slowly and maximally. Close your lips around the mouthpiece without covering the drug release hole. Aim the fine-particle inhaler toward the back of the throat. While taking a slow, deep breath in, press the dose release button and continue to inhale slowly. Take the inhaler out of your mouth and hold your breath for 5-10 seconds then exhale gently. Close the inhaler cap. If another dose is needed, repeat the procedure outlined above.

4. How to use aerosol sprays

Aerosol sprays are drugs that are made in liquid form but are used as a mist. When inhaled, the drug mist particles will go deep into the smallest airways in the lungs. The amount of medicine required in a dose is prepackaged in each ampoule. At the same time, the use of nebulizers also requires a nebulizer and a mask.
The machine is usually powered by electricity and has significant limitations in convenience and portability when compared to the three inhalers mentioned above. However, this is the way to use topical sugar drugs in the treatment of respiratory diseases that is suitable for all subjects and is especially appropriate in the acute setting.

To use the inhaler with the nebulizer, follow these steps:
Wash your hands with soap and water to prevent germs from entering the lungs. Place the unit on a hard surface and check the cleanliness of the air filter. If dirty, wash it with cold water and let it dry naturally. Plug the power into the machine. Remove the cap of the vial by twisting and inserting the medicine into the medicine compartment of the mask. Physiological saline or distilled water may be added if the volume is to be increased but not to exceed the capacity of the drug container. Always keep the mask upright to avoid spilling the medicine. Connect the mask to the nebulizer using the extension cord. Wear a mask that covers your nose and mouth. Turn on the machine and inhale, exhale deeply, slowly through the mouth until the fog clears. An entire nebulizer application can take up to 20 minutes. Finish by turning off the machine, disconnecting the power, removing the mask and wiring. Rinse the mask off with clean water and let it dry naturally before the next use. If using a nebulizer containing steroid drugs, rinse your mouth with clean water after spraying to remove excess medication deposited in the mouth and throat. After that, the water must be spit out, not swallowed.
If more or more aerosol sprays are required, they can be mixed or used in succession without the need for a new mask or re-cleaning.
In summary, inhaled drugs are quite common in the treatment of respiratory diseases. Depending on the situation, each patient and the goal of treatment, the doctor will prescribe different drugs. However, the general rule is always to use the inhaler correctly, providing maximum treatment effectiveness and minimizing drug waste and unwanted side effects.

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