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Inhalers are available in many shapes and sizes, with differing flow rates and some only available or licensed for specific indications or available in fixed dose combinations, which may limit their intended use in practice. Generally, it is usual to initiate an MDI when starting therapy.2
Patients should be offered choice and matched to a device they are able to use. Those patients using an MDI (in particular for ICS) should use it with a spacer device to improve lung delivery and minimise side-effects such as candiasis (and also rinse out their mouth after ICS inhaler use).7
Patients should not be switched to alternative devices without consent and should be assessed in the use of the new device if a change is required.2,3 Technique will differ with new devices but there are some general principles that are common such as remaining upright, making a tight seal with the lips around the mouthpiece after removing the cap and co-ordinating actuation and inspiration.
The seven-step8 approach for inhaler technique can be followed:
Generally, for MDIs the advice is to breathe deep and slow. For a DPI, the patient should breathe deep and fast. The following rhymes may help patients remember. ‘If you want Me to flow then just breathe slow’ (where Me is MDI). For DPIs: ‘the powder works a blast if I breathe deep and fast’.
Author: Ravijyot Saggu