Introduction

1. Greet the patient and introduce yourself
2. Confirm patient details ✍
3. Check the current technique the patient uses
4. Check the patient is not in any pain
5. Wash hands ✋

Explanation

Briefly describe the inhaler the patient is on:

 Reliever inhalers (e.g. salbutamol)

 Relieves sudden asthma attacks

 Relaxes airways to enable easier breathing

 Inhale when you feel short of breath (no more than 3x per week as assessed by GP)

 Preventer inhalers (e.g. beclomethasone)

 Reduces airway swelling to prevent tightening

 Used to reduce asthma attacks

 Inhale ‘x puffs x times per day’ (regular dose)

 Rinse mouth afterwards to prevent oral candidiasis

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

 Both a preventer and a reliever

 Use this regularly, ‘x puffs twice per day and x puffs when having an asthma attack’

 Rinse mouth afterwards to prevent oral candidiasis

Check the patient’s understanding:

 Ask them to summarise what you have told them

Demonstrate the effective technique for the inhaler

 Pressurised metered-dose inhaler (pMDI) isdescribed here as it is commonly used in OSCEs

Preparation:

1. Test remove the cap, shake and test the inhaler before using if it has not been used for ≥ 5 days
2. Check dose counter  regularly check if the dose counter is running low so you can get a replacement before running out
3. Check the expiry date usually found on the metal cannister, after this date it will no longer be effective 📅

Procedure:

1. Prepare the inhaler:
   1. Hold inhaler upright
   2. Remove cap
   3. Shake inhaler
2. Inhalation:
   1. Sit up
   2. Tilt chin up
   3. Seal your lips 👄 around the mouthpiece
   4. Breathe in slowly as you press the cannister down
   5. Continue breathing in until your lungs feel full
   6. Remove the inhaler from your mouth 👄
   7. Close your lips 👄
   8. Hold your breath for 10 seconds
   9. Breathe out gently 
3. Finish:

               1.    Replace the cap

               2     Rinse your mouth if the inhaler contained steroids 👄

 If you are prescribed 2 puffs at any one time, wait 30 seconds to 1 minute, then repeat

Assess the patient’s technique

 Ask the patient to demonstrate what you have just explained and provide positive feedback until they are using the inhaler correctly ✅

Describe and explain Spacer devices

 Spacers can aid the deposition of the corticosteroids into the lungs and thus decrease the amount in the mouth, reducing side effects!

 Volumatic and AeroChamber are commonly used Spacer devices.

1. Prepare inhaler
2. Attach the mouthpiece of the inhaler to the spacer
3. Breathe out to empty your lungs
4. Wrap your lips 👄 around the mouthpiece of the spacer
5. Breathe in and out deeply through the spacer, several times
6. Repeat if prescribed

 Spacer devices must be washed monthly with detergent

 You should air dry your spacer, do not wipe as the resulting static could cause the corticosteroid particles to stick to the device

 Replace your spacer device annually

Complete the consultation

1. Ask if the patient has any remaining questions ❓
2. Explain the side effects ❌ of not following the technique you have demonstrated

          Oral thrush                

          Palpitations and tremor

        3. Advise the patient to call 999 if they do not respond to 10 puffs of their inhaler when having an asthma attack

        4. Give the patient the relevant information leaflet to remind them of the technique 

        5. Organise follow up appointments so you can see how they are getting on with the inhaler technique

        6. Thank the patient

        7. Wash hands ✋

Summary:

1. Greet the patient
2. Explain and describe the type of inhaler
3. Demonstrate the technique for this inhaler
4. Assess the technique the patient uses 
5. Explain and demonstrate how to use spacer devices 
6. Complete the consultation by explaining potential side effects