Correct Use of Medications

A spacer acts as a reservoir for aerosols produced from MDI’s and allows almost twice as much medication to reach the lungs and penetrate the airways, compared with a MDI inhaler alone (Fig 1).

Studies with Asthma and COPD have shown that equivalent doses of medication given through a spacer device, can achieve the same effect as using a nebuliser.

Note:

Never put more than one puff (actuation) of drug into the spacer at any one time. The second dose will mean many smaller particles will impact on the large particles being held in the chamber and will cause them to rain out losing a large proportion of drug dosage.

Cleaning and Maintenance of spacers

Cleaning should be carried out after approximately 2 weeks of daily use – cleaning more frequently increases the static inside the spacer which will reduce the quantity of medication reaching the lungs.

Wash all sections in warm soapy water. Do not rinse the spacer parts (to reduce the build-up of static electricity within the spacer).

Allow to dry naturally (ie, air dry – do not wipe dry).

Re-assemble all components ready for next use.

Types of spacers

Small volume eg, Breath-a-Tech, Aerochamber, OptiChamber Diamond

Large volume eg, Volumati

Large volume spacers are preferred over smaller spacers and should be used in the following instances:

By all adult patients who have poor co-ordination when using a MDI.

Children of all ages can use an MDI and spacer. Children over 4 years can use a MDI and a large volume spacer. Children under 4 years can use an MDI and a small volume spacer (Aerochamber, Breath-a-tech, OptiChamber Diamond) with a face mask (Fig 2).

By all patients using inhaled corticosteroids, to reduce the incidence of oropharyngeal side-effects and the risk of systemic side-effects.

During an acute attack, the administration of a high dose short-acting beta-agonist via an MDI and large volume spacer is an effective alternative to a nebuliser.

Patients are encouraged to take a slow deep breath in, with a breath hold, when using a spacer.

In children (who are unable to take deep breaths on request) 4 – 5 tidal breaths with a large volume spacer will give the same delivery of drug as one large deep breath.

Nebulised medications

An appropriate nebuliser, with a small particle size, is desirable to administer medications to the lungs for people with bronchiectasis.

For a detailed description of nebuliser therapy – Inhaled Medications via a Nebuliser

Nebulised medications for bronchiectasis:

Isotonic saline (0.9%) – no prescription required

prescribed nebuliser – inhaling with breaths of varied depths

5 mls once or twice a day

prior to, or in conjunction with, the airway clearance routine

PEP device can be added to the nebuliser if necessary

Hypertonic saline (6%-7%) – prescription required

a lung function test is required to ascertain bronchial sensitivity

the lung function test may need to be supervised by a medical practitioner if the FEV1 is less than one litre at baseline

therapy is not recommended if the FEV1 decreases by more than 15% after the HTS challenge

a bronchodilator should be administered before every session of hypertonic saline

prescribed nebuliser – inhaling with breaths of varied depths

5 mls once or twice a day

prior to, or in conjunction with, the airway clearance routine

PEP device can be added to the nebuliser if necessary

Colistin – prescription required

a test dose should be given under supervision prior to home use

when using at home either attach a filter to the nebuliser or use the nebuliser in a well ventilated room

PEP device should not be added to the nebuliser

Tobramycin – prescription required

a test dose should be given under supervision prior to home use

when using at home either attach a filter to the nebuliser or use the nebuliser in a well ventilated room

PEP device should not be added to the nebuliser