correct inhalation tecnique

inhaled medication is a major therapeutic option for obstructive airway disease. However the correct method to use inhaler is very important for effective delivery of drugs to lung. Here the essential steps for correct use of inhaler will be given. For more detail see the article "Correct Inhalation Technique: ERS Task Force Guidelines Eur Respir J 2011; 37: 1308–1331"

pMDIs: for patients with good actuation–inhalation coordination

1) Shake four or five times if suspension formulation.

2) Take the cap off.

3) Prime the inhaler

4) Exhale slowly, as far as comfortable

5) Hold the inhaler in an upright position.

6) Immediately place the inhaler in the mouth between the teeth, with the tongue flat under the mouthpiece.

7) Ensure that the lips have formed a good seal with the mouthpiece.

8) Start to inhale slowly, through the mouth and at the same time press the canister to actuate a dose.

9) Maintain a slow and deep inhalation, through the mouth, until the lungs are full of air. This should take an adult 4–5 s.

10) At the end of the inhalation, take the inhaler out of the mouth and close the lips.

11) Continue to hold the breath for as long as possible, or up to 10 s before breathing out.

12) Breathe normally.

13) If another dose is required, repeat steps 4–12.

pMDI + spacer with facemask: for patients ≤3 yrs old or anyone who cannot breathe consciously through the mouth

1–3) Same as above for pMDIs alone.

4) Insert the mouthpiece of the pMDI into the open end of the spacer and ensure a tight fit

5) Place the facemask over the nose and mouth and be sure the fit is tight to the face.

6) Actuate one dose into the chamber of the spacer.

7) The patient should inhale and exhale normally into the spacer at least 10 times.

8) Take the facemask off the patient's face.

9) If another dose is required, repeat steps 1–8.