Question

A practical nurse must know how to reinforce instruction on correct use of the inhaler for the asthma patient! After viewing the video on inhalers post 3 key steps to remember when using inhalers. Next discuss what strategies you will use to encourage asthma patients to be compliant.

Answer 1

The key to proper use of these inhalers is drawing the spray or mist released from the mouthpiece of the inhaler deep into the lungs and onto the bronchial tubes. We recommend that you put your lips and teeth tightly around the mouthpiece of the inhaler. Alternatively, it is also proper to hold the mouthpiece a distance of about one inch from your opened mouth.

Then, three steps are important. First, start breathing in as soon as the spray has been made. If you wait to breathe in too long after making the spray, you lose a lot of medication that settles onto your tongue and mouth rather than being drawn onto your breathing tubes. At the other extreme, if you breathe in deeply before the spray is made, you will not have enough breath left to pull the medicine onto the bronchial tubes. So, to do it just right, at the same time that you are pressing down on the canister and making the spray, begin to breathe in.

Second, breathe in slowly. It takes time to distribute the medication to the thousands of bronchial tubes; too fast a breath puts most of the medicine onto the back of the throat and the upper breathing passageways only. Try not to rush as you breathe in; it should take about 3-4 seconds to pull in a slow, full breath.

Third, hold your breath for a few seconds at the end of the slow, deep breath. If you breathe out immediately, you lose some of the medication in what you exhale. Give the medicine a chance to settle onto the breathing tubes by holding your breath for about 5 seconds before exhaling.

2- General strategies to Enhance asthama patients to compliance

1. ....Modify or negotiate regimens. Physicians should forge a partnership with families to devise a regimen with which they are most likely to comply.15 Parents are likely to express preferences for (or difficulties with) certain schedules; also form and palatability should be considered individually with each patient, as multiple options frequently exist. Determine whether cost or other barriers will impede compliance.
2. Improve communication between physician and patient and/or family. The practice setting, time management, specific questions to patient and/or family, education, focused and written materials given to the patient and/or family, and an atmosphere of encouraging the expression of questions or concerns all contribute to improving communications and compliance
3. Emphasize patient self-management of disease or illness. Taking ownership for managing one's condition results in increased motivation to understand the illness or treatment plan
4. Use technology and devices. Novel technologies are available to enhance compliance. Examples include insulin pumps, intranasal administration devices, needle-free delivery systems, and devices that count actuations of an inhaler or opening a bottle. Age-appropriate adaptations of currently used devices can also be useful.
5. Use the simplest effective regimen available. In some contexts, directly observed therapy may be necessary in the short term to enhance adherence75 or for public health reasons, as in tuberculosis. Single-dose or few-dose regimens leave little opportunity for failed compliance. Once-a-day dosing reduces complications from multiple caregivers, dependence on schools, and schedule issues. Examples are single-dose antibiotics for otitis media, extended-release dosage forms that are emerging, and hormonal depot injections