Video Inhaler Part 2 Versi 3

Summary

The video explains two types of inhalers: metered-dose inhalers (MDIs) and dry-powder inhalers (DPIs). It describes how they work, their advantages and limitations, and how to use an MDI, an MDI with a spacer, a Breezhaler, and a Turbuhaler.

1. Metered-Dose Inhalers (MDIs)

An MDI delivers a measured dose of medicine when its canister is pressed. A typical pressurized MDI has a canister inside a plastic casing with a mouthpiece. The canister contains medicine mixed with a liquid propellant.

The inhaler should be shaken before use to mix its contents. Pressing the canister releases an aerosol through the mouthpiece, so the user must coordinate pressing the canister with inhaling.

Advantages

• Small and portable.
• The sealed, pressurized canister helps protect the medicine from moisture and contamination.

Limitations

• Correct use requires coordinating a press with a slow inhalation.
• Propellants raise environmental concerns. The video notes ozone-depleting effects associated with CFCs and greenhouse-gas emissions from inhaler propellants.

2. Using an MDI

1. Shake the inhaler and remove the cap.
2. Hold it upright and breathe out as fully as possible.
3. Put the mouthpiece in your mouth.
4. Press the canister as you begin to inhale.
5. Continue breathing in, then hold your breath for about 10 seconds.
6. Breathe out slowly. Repeat if another dose is prescribed.

3. Using an MDI with a Spacer

A spacer can help when someone has difficulty coordinating pressing and inhaling, such as some children, older adults, or people with cognitive or coordination difficulties. The video also says spacers may be used when someone cannot hold their breath for several seconds, needs high-dose inhaled corticosteroids, or is experiencing a severe exacerbation. It notes that spacers can reduce oropharyngeal candidiasis.

Steps for using a spacer with a face mask

1. Shake the MDI three or four times.
2. Remove the caps from the inhaler and spacer.
3. Fit the inhaler and mask to the spacer.
4. Breathe out away from the spacer.
5. Place the mask over the nose and mouth.
6. Press the inhaler once to release one puff into the spacer.
7. Keep the mask in place for five to ten breaths.
8. Remove the mask, wait about 30 seconds, and repeat for each prescribed puff.

4. Dry-Powder Inhalers (DPIs)

DPIs contain medicine in powder form. The formulation commonly combines fine medicine particles with larger carrier particles, such as lactose, to improve powder flow.

DPIs are breath-activated: the user’s inhalation disperses the powder, so pressing and inhaling do not need to be coordinated as they do with an MDI. The patient must generate enough inspiratory flow to disperse and deliver the medicine. For this reason, the video says DPIs are generally not recommended for children under six, who may not inhale with sufficient flow or volume.

During inhalation, turbulence separates the medicine particles from the larger carrier particles. The carrier particles tend to remain in the mouth and throat, while the medicine can travel deeper into the lungs.

The video describes three device categories:

• Single-unit-dose devices: The patient loads an individual capsule or blister before use.
• Multiple-unit-dose devices: The inhaler contains a series of capsules or blisters.
• Reservoir devices: The patient measures a dose from powder stored inside the device.

Advantages

• No propellant is needed, making DPIs more environmentally friendly in this respect.
• Breath activation avoids the press-and-breathe coordination required by MDIs.
• They can be convenient, including for combination therapies.

Limitations

• The amount of medicine delivered can vary if the user cannot inhale strongly enough.
• Powder can be moisture-sensitive, so users should not breathe out into the device.
• A strong, rapid inhalation may be difficult during an emergency or for some children and people with respiratory disease.

5. Breezhaler

The Breezhaler is described as a single-dose capsule DPI with low airflow resistance. Its capsule provides visual, audible, and sometimes taste-related feedback that may help users tell whether the dose has been inhaled. Users still need to generate sufficient inspiratory flow.

Steps described

1. Remove the cap and open the mouthpiece.
2. Take a capsule from its blister and place it in the chamber.
3. Close the mouthpiece until it clicks.
4. Press and release the side buttons once to pierce the capsule. Do not shake the device.
5. Breathe out gently, away from the inhaler.
6. Put the mouthpiece between your teeth without biting it, and seal your lips around it.
7. Inhale rapidly and steadily, continuing for as long as comfortable.
8. Hold your breath for about five seconds, or as long as comfortable.
9. Remove the inhaler, breathe out gently away from it, and open it to check the capsule.
10. If another dose is prescribed, repeat from the capsule-loading step.

6. Turbuhaler

The Turbuhaler is described as a reservoir DPI. Twisting its grip loads a dose; inhalation carries the powder through channels designed to create turbulence and separate the particles. The video gives a minimum inspiratory flow rate of about 30 L/min for a therapeutic dose and notes that the device has a dose counter.

Advantages

• Holds multiple doses in a compact, portable device.
• Requires no propellant and reduces the coordination needed between actuation and inhalation.
• Has a dose counter to indicate the remaining doses.

Limitations

• Requires a sufficiently strong, rapid inhalation.
• The video notes this may be difficult for some pediatric patients and people with asthma or COPD.
• A strong inhalation helps deliver more medicine to the lungs.

Steps described

1. Unscrew the cap while holding the device upright.
2. Twist the grip fully in one direction, then back in the other direction until it clicks. The video says to do this twice before first use and once for subsequent doses.
3. Breathe out away from the mouthpiece.
4. Place the mouthpiece between your lips and inhale deeply.
5. Hold your breath for about 10 seconds, then remove the inhaler from your mouth and breathe out gently.
6. Repeat if more than one dose is prescribed, then replace the cap tightly.

The video concludes that it has covered MDIs and two DPIs, and says a later video will discuss additional multidose DPI devices.

Speakers and Sources

• Speaker: One unnamed narrator presents the educational material; no other speakers are identifiable in the subtitles.
• Publisher/channel: Departemen Farmakologi dan Terapi FKKMK UGM.