Inhaler Consultation
12
October

By Adem Lewis / in , , , , , , , , , /


Hello My name is Liz and I am a respiratory
nurse. In this video we offer a practical guide to
having a consultation about inhalers. When discussing inhaler treatment with patients
it is important to practice shared decision making and support self management. Links to resources that explain these principles are provided in the documents which accompany this video. Before proceeding, let’s take time to familiarise
ourselves with the terms concordance, compliance and adherence. These are often used interchangeably and sometimes
cause confusion. Concordance refers to the practice of working
in partnership with patients to agree a treatment plan. Compliance refers to the act of following
the treatment plan. Adherence refers to sticking with the treatment plan. Studies have found poor adherence with inhaled therapy. The following may have a negative impact on
compliance and adherence. Fear of adverse effects. Belief that the medication is not needed,
or will not work. Not knowing what the medication is for Complexity of the device. Complexity of the treatment regime. Agreeing a treatment plan with the patient
may improve compliance and adherence. When prescribing inhalers clinicians should
adhere to local prescribing preferences where possible. You should be able to get a copy of these
from a prescribing advisor or respiratory specialist. These are ours and like most I have seen they
provide a mix of devices that are easy for the patient to use and for the patient to
fit into their daily routine. As well as being both effective and cost effective. In practice I keep copies in my inhaler bag
and on my computer so that I have access to them at all times. Use single disposable devices and equipment to check patients’ inhaler technique at all times. You should not use one device on many patients. In this video we use a NEXThaler only because we happen to be filming a patient video for this today. The essence of the consultation is applicable
to any inhaler. Each patient consultation should include: Discussing treatment options. Having a conversation with the patient
to find out what their aims and hopes for treatment are. What concerns or fears they may have. How to store the inhaler.
How to use the inhaler. Cleaning the inhaler. What to do if they forget to take a dose,
or double dose. Replacing the inhaler. Going to the hospital or clinic. Hi Jill. What information have you been given about
today’s appointment? Well I know I have got COPD and I am here
to find out more treatment I can get for it. I have got these 2 inhalers and they do
help but I am still struggling with it. OK, in what way are you struggling? I am struggling with my breathlessness. I know it won’t go away completely but I
want to get it better. I keep getting chest infections and it’s
just getting me down. OK, it sounds like reducing the breathlessness
and the amount of flare-ups is important to you. Yes. Before we go on would it be OK if I could just check that you are using your inhalers correctly? Yeah. That’s good, you are using them correctly. So tell me about your daily routine, including
when you take your pills and inhalers. Well I get up at about 8 and
then I get my breakfast and I take my pills and my inhaler after that. Then I go about my day and then at night time
I take my pills and inhaler before I go to bed. OK, do you always remember to take your pills
and inhaler? I always remember to take my pills, but I do
sometimes forget my inhaler. OK, when you say you sometimes forget, how often say in 1 week
would you forget to take your inhaler? Not often, just sometimes. Once in a blue moon. Once a month or something. So Jill where do you keep your pills? I keep them in the cupboard in the living
room. OK what about your inhalers? I keep them in the kitchen. I suppose I should keep them together
shouldn’t I? Would it help you to remember to take them? Yes, yes, that’s what I’ll do. I’ll store them all together. Right, the living room would be a good place
to store them because they should be kept in a dry environment away from heat and children. Tell me, would children be able to get into
the cupboard in the living room? No, no it’s high up and we keep it locked. So we know that you are using your inhalers
correctly and that you are using them when you should. So we can now look at inhalers that might
help to reduce the breathlessness and the amount of flare-ups that you are having. These are the ones that the chest specialists
recommend. And which one is the best one? There is no evidence that one is better than
the other. However you are using powder inhalers and
you are managing them well, so I think we should maybe stick with them. So we should maybe just take this one out
of the equation because it works a wee bit differently. So then you are left with these 2, OK. They are both used in similar ways and they
are both used to help reduce the frequency and severity of flare-ups. OK, this one you would just take 1 puff
in a morning. And this one you would take 2 puffs morning
and night. It really just depends on what you
would prefer to do? OK, I think it would be easier if I use it
the same as these ones when I take it twice a day. OK. So I will tell you a bit about this inhaler
and then I will show you how to use it. So this inhaler has got 2 drugs in it and
they will help to reduce the breathlessness and the amount of flare-ups that you are having. It is really important that you take it morning
and night whether you need it or not. Because they can take up to 6 weeks to work. So it should be taken whether you have got
infection or not every day. So it will go on your repeat prescription,
OK. So you just need to make sure and renew it
at the end of every month, but we will talk a bit more about that later. But it won’t interfere with my other medications
or my other medical conditions will it? It shouldn’t do but if you experience any
side effects then just give us a call, OK. The main side effect of this is that it can
cause voice hoarseness, and a bit of thrush in your mouth. After you have used it rinse out your mouth
and brush your teeth. OK. So how do I use this inhaler? OK, I’ll show you how to use the inhaler. When you get the inhaler there will be instructions
inside the box so take them out and that will show you how to use it. OK, you should take the inhalers at the same
time every day. You can take them with or without food. And when you are taking it keep your head
in a neutral position. So this is the inhaler. If you open that up that’s the dust cap. OK and when you open it up
you will hear it click. This is the mouth piece so you just have to
make sure that when you are not using the inhaler that the dust cap is covering
the mouthpiece. You don’t want any dirt or
dust to get in there. These are the air vents so make sure you don’t
cover them with your fingers or your clothes. At the front there is a dose counter, that counts from 120 down
so you know when you are getting empty. And at the back here, there is a label and
on that label you would just put the date for 6 months from when you opened it because
that’s when the drug will expire. But you will be getting a new one every month
so it shouldn’t expire. So to use it, you will open that up
and hear the click. You breathe out, but not in to the device. So like this. EXHALES. Put it in your mouth, seal with
your lips and breathe in hard and fast and hold your breath from 5 to 10 seconds. So like this, I will show you from the beginning. EXHALES INHALES EXHALES And then breathe out. So you will have to take another puff so just
wait, close it over and do the same again. This time listen out and
you will hear it click. OK, so that’s when you know you are using
it properly. Open up, click. EXHALES INHALES EXHALES When you have finished just give it a wipe
with a clean dry tissue, and close it over.
Then that’s you. Just have a look at the dose counter
to make sure that you are not running out. So Jill, I’ll let you have a wee practice
but once it is opened I will put this disposable mouth piece cover on it for you OK? So I have to open it until it clicks. That’s right. So I breathe out, then I breathe in. EXHALES INHALES EXHALES Is that right? That’s fine and then you would just repeat
that again for your second puff. Then again just remember to clean it OK. After you have used it remember to check the
dose counter. It will count from 120 downwards so you know
when it is getting empty. When you get to about 10 doses put in your
repeat prescription. After you have used it rinse your mouth out
and brush your teeth as I say just to prevent voice hoarseness and thrush. What if I forget to take it? If you forget to take it, take it if you remember
within an hour or 2. Anything more than that just forget it and
get back on track with the next dose. OK. And what happens if I take too much? If you take too much just give us a phone
and we will advise you. What do I do if I forget how to use this once
I’m back home? If you forget how to use it then there’s
a few things you can do. There’s the pictured instructions inside
with your inhaler leaflet. You can also ask the pharmacist, they will
show you how to use it. There is also this website My Lungs My Life. It’s got videos on it that shows you how
to use them so you can review it from the comfort of your own home. OK. Thank you. When you are going to the hospital or clinic
take your inhalers with you, along with a list of all your medications
that you are on. It is really important you take your inhalers
with you because they may not have the inhalers that you are on. So, that’s us.
Are there any questions Jill? No that has been really helpful. Thank you. If you have any questions
then just give us a phone. OK.


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