How To Clean Metered Dose Inhaler Mouthpiece

Explaining constructive inhaler technique is a common OSCE scenario and requires you to both describe and demonstrate the skill. This step-by-step guide describes how to explain inhaler technique in an OSCE setting.

Download the inhaler technique PDF OSCE checklist, or use our interactive OSCE checklist.

Opening the consultation

Launder your hands and don PPE if appropriate.

Introduce yourself to the patient including yourname andfunction.

Ostend the patient'southwardname andengagement of birth.

Cheque the patient's current understanding of inhaler technique, assuasive you to better tailor your explanation.

Position the patient then that they are sitting comfortably.

Ask the patient if they accept anypain orshortnessofbreath before get-go your explanation of inhaler technique.

You lot might also be interested in our OSCE Flashcard Collection which contains over 2000 flashcards that embrace clinical examination, procedures, advice skills and data interpretation.

Explanation

Overview

Provide a general overview of the patient'south inhaler:

"You have been started on ….(name of inhaler)…for your asthma."
"This is what the inhaler looks similar."
"This is the mouthpiece, this is the canister containing the medication and this is the dose counter."

Dissimilar types of inhaler

Reliever (e.g. salbutamol inhaler)

Explain what a reliever inhaler is and when it should be used:

"(Name of inhaler) is a reliever. This is useful to help salve sudden asthma attacks. It works by relaxing the airways and so that yous can breathe more hands. You shouldn't demand this more than three times a week if your asthma is well controlled. Ask your GP for a review if you are using this more frequently. I would similar you to inhale (10 puff(due south)) when yous experience short of jiff."

Preventer (e.grand. beclomethasone inhaler)

Explain what a preventer inhaler is and when it should be used:

"(Name of inhaler) is a preventer – it helps to reduce the swelling in the airways and stops them from tightening up. Yous utilise this inhaler to reduce the take a chance of having asthma attacks. I would like you lot to inhale …(x puff(due south))…(x time(s) a day)…everyday. It'due south actually important that you don't miss doses, every bit regular use is fundamental to keeping your asthma under control."

Remind the patient to rinse their mouth after use due to the increased risk of oral candidiasis:

"You should rinse your mouth subsequently you use this inhaler every bit otherwise, you might develop a sore and inflamed mouth."

SMART (Unmarried Maintenance and Reliever Therapy) regime (e.g. Symbicort, Fostair, Duoresp, Spiromax)

Explain what a SMART inhaler is and when it should exist used:

"Symbicort is used as both a preventer and a reliever. Y'all demand to use this regularly …(x puff(s))…twice a day to preclude symptoms and …(ten puff(s))…each time y'all have an assault."

Remind the patient to rinse their mouth after apply due to the increased risk of oral candidiasis:

"You should rinse your mouth after you use this inhaler as otherwise, yous might develop a sore and inflamed mouth."

Check the patient'southward understanding

Ask the patient to summarise the key points back to you to check their understanding:

"To make sure you lot've understood everything I've said could you tell me what type of inhaler yous have and when it should exist used? Don't worry if you tin't recall everything correct away, we can always go back over the important information."

Demonstrate effective inhaler technique

The guide below focuses on correct inhaler technique using a pressurised metered-dose inhaler (pMDI), which is about unremarkably used in OSCE scenarios. ⁱⁱ

Ensure y'all conspicuously explain and demonstrate each of the following steps to the patient using a dummy inhaler.

Things to do before using the inhaler

There are several things you should advise the patient to do before they begin to apply their inhaler.

Device test

If the inhaler hasn't been used for 5 days or more, the patient should exist advised to test the device earlier using it:

1.Remove the cap and shake the inhaler well.

2.Betoken the mouthpiece away from you and press the canister to release a puff into the air.

Dose counter

Some pMDI's have a dose counter which shows the number of remaining doses left in the inhaler. Advise the patient to check the inhaler is not empty and to seek a replacement whilst they all the same have several doses left.

Decease date

The decease date shows when the medication within the inhaler will expire and no longer be effective. The decease date is typically located on the metal canister of the inhaler. Advise the patient to seek a replacement in advance of their inhaler expiring and to avoid using it subsequently the expiry engagement.

Procedure

Grooming

1. Hold the inhaler upright.

ii. Remove the cap from the inhaler and inspect to make sure in that location is nothing inside the inhaler mouthpiece.

3. Milkshake the inhaler well.

Inhalation

iv. Sit down or stand upwardly straight and slightly tilt your chin up. This position helps the medication to better reach the lungs.

5. Exhale out gently and slowly away from the inhaler until your lungs feel empty.

6. Put your lips around the mouthpiece of the inhaler to create a tight seal.

vii. Start to exhale in slowly and steadily whilst at the same time pressing the canister on the inhaler one time.

8. Continue to breathe in slowly until your lungs feel full.

9. Remove the inhaler from your rima oris and seal your lips.

x. Concord your breath for ten seconds, or equally long as you are comfortably able to.

11. Breathe out gently, abroad from your inhaler.

Final steps

12. Once y'all take finished using your inhaler, supervene upon the cap. If y'all've used an inhaler that contains steroids, rinse your rima oris with water to reduce the adventure of side effects.

Multiple doses

If you've been prescribed a second puff, wait xxx seconds to a minute for repeating steps 3-12.

Assess the patient's inhaler technique

Inquire the patient to use their own inhaler as demonstrated and find their technique.

Provide feedback based on what you notice to let the patient to refine their technique.

Point out the positives…"Y'all are doing X&Y very well"… then introduce room for improvement …"but doing A&B may assist your inhalers work more effectively for you lot."

Continue to repeat the bicycle of observation and feedback until the patient is able to use their inhaler finer.

Spacer devices

Spacers are used to ameliorate drug degradation in the lungs. They are too useful for reducing the side effects of high dose inhaled corticosteroids by decreasing the amount of drug deposited in the mouth. Usually used spacers include Volumatic and AeroChamber.

Ensure you clearly explain and demonstrate each of the following steps for effectively using a spacer to the patient:

one. Set up the inhaler as previously explained.

two. Adhere the inhaler mouthpiece to the spacer device.

3. Exhale out gently and slowly away from the spacer until your lungs experience empty.

iv. Place your lips effectually the spacer mouthpiece to create an effective seal.

v. Release one dose of the inhaler into the spacer device.

6. Exhale deeply, both in and out, through the spacer mouthpiece several times.

7. Administer a second dose if required.

Spacer device care instructions

The spacer device should be done with detergent (washing up liquid is fine) one time a month and left to air-dry.

Information technology should never exist wiped dry every bit this can cause static within the device and drug particles will stick to sides of the spacer as a consequence.

Spacers should be replaced at least once a yr.

Closing the consultation

Bank check if the patient has anyquestions regardinginhaler technique.

Propose the patient to apply their inhalers as directed.

Explicate the potential side effects they may feel when using their inhalers:

Palpitations and tremor: salbutamol tin crusade tachycardia and tremor, particularly at higher doses.
Oral thrush: steroid inhalers can cause candidiasis, particularly if the patient doesn't wash their rima oris out effectively after each use.

Advise that if the patient has an asthma assault that does not respond to their salbutamol inhaler after 10 puffs (with xxx seconds between each puff) they should call 999 for urgent medical cess.

Provide an information leaflet for the relevant inhaler device.

Adjust a follow-up appointment to re-assess the patient's inhaler technique.

Thank the patient for their fourth dimension.

Dispose of PPE appropriately and launder your hands.

References

James Heilman, MD. Adapted by Geeky Medics. Oral candidiasis. Licence: CC BY-SA. Available from [LINK].
Asthma UK. How to utilise a pMDI inhaler. Accessed on 12th June 2020. Bachelor from: [LINK].
Tradimus. Adjusted past Geeky Medics. Spacer device. Licence: CC BY-SA. Available from: [LINK].

Source: https://geekymedics.com/inhaler-technique-osce-guide/

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