Asthma treatment - inhalers

Patients with asthma are usually prescribed two types of inhalers- a ‘reliever’ or a ‘preventer’. Relievers are used for immediate relief of asthma symptoms (e.g. wheezing and shortness of breath). Preventers are used regularly to provide long-term control and prevent symptoms. At times, a combination inhaler (both a reliever and preventer) may be prescribed.

Inhalers are well-designed to deliver medication in the form of aerosol, mist or dry powder. These go directly into the lung for faster action and lesser side effects as compared with oral medication.

Correct inhaler technique plays an ESSENTIAL part in ensuring that you receive the optimum amount of medication, and thus the desired outcome i.e. good control of asthma.

Please consult your doctor or pharmacist if you are unsure regarding the technique.

Features
  • Dry powder inhaler (DPI)
  • No coordination required
  • Comes with a dose indicator diseases such as cancer (Indicates the amount of doses remaining, RED indicator means that it’s time to get a new device, ‘0’ means it’s time to use a new device)
  • Device dispenses a small amount of very fine powder-like medication directly into the lungs
Priming (Using it for the first time only)
  • Unscrew the cap and lift it off
  • Hold the Turbohaler upright
  • Turn the grip as far as it will go in one direction and back again
  • You will hear a click sound. Repeat and 2nd click will be heard
How to use?

Step 1 : Unscrew the cap and lift it off

Step 2 : Load the turbuhaler
  • Hold the device upright
  • Turn/’TWIST’ the red as far as it will go in one direction and back again as fair as it will go
  • You will hear a ‘CLICK’ (Now ready for use)
  • Breathe out as far as you comfortably can, away from the device

Step 3 : ‘INHALE’ the medication
  • Place mouthpiece gently between your teeth, without biting. Breathe in forcefully and deeply (not through your nose). Do not cover the air vent
  • Remove the device from your mouth
  • Hold your breath for about 10 seconds or as long as you comfortably can. Then breathe out slowly
  • Repeat step 2 to 3 if more than one dose is required

Step 4 : Replace the cap
  • Screw the cap back on
  • Do not turn the red grip again

Step 5 : Rinse your mouth with water
How to care and clean?
  • Wipe the inhaler with clean, dry tissue. Do not wash any part of the Turbuhaler
Special note
  • May not feel or taste anything during or after inhalation
  • If the device is twisted more than once during the loading procedure, you will still only receive a single dose of medicine. However, the dose indicator will register all the loaded doses every ‘Click’
  • Never breathe into your device
  • The powder you hear when you shake the device is NOT medication, it is a drying agent.
Available Brand in Malaysia (Full list may not be displayed here)
  • Symbicort® Turbuhaler (Budesonide/Formoterol)
  • Pulmicort® Turbuhaler (Budesonide)
  • Bricanyl® Turbuhaler (Terbutaline)
References

Product Information Leaflet, Handling of inhaler devices, A Practical Guide for Pharmacists (1st ed), Pharmaceutical Services Division, MOH, 2010

Features
  • Propellant-free technology works just with the power of tensioned spring
  • Dispenses fine and easy to inhale droplets directly deep into the lungs with less disposition on the throat
  • Requires very less effort during inhalation
  • Comes with a dose indicator (Pointer at Red zone means enough medication left for approximately 14 puffs and this is when you need to a get a new prescription)
Prepare for first time use
  • Load and push the narrow end of the cartridge into the inhaler (may be pushed against a firm surface to ensure it is correctly inserted)
  • Do not remove the cartridge once it has been inserted into the inhaler.
  • Put the clear base back into place.
Priming (Using it for the first time only)

It will not affect the number of doses available in the inhaler. After preparation and initial priming, your inhaler will be able to deliver the labeled number of doses. Proper priming of the inhaler is important to make sure the correct amount of medicine is delivered.

  • Hold the inhaler upright, with the aqua cap closed, to avoid accidental release of dose.
  • Turn the clear base in the direction of the red arrows on the label until it clicks (half a turn).
  • Flip the aqua cap until it snaps fully open.
  • Point your inhaler toward the ground (away from your face). Press the dose-release button. Close the aqua cap. Repeat steps 1 to 4 until a spray is visible.
  • Once the spray is visible, you must repeat steps 1 to 4 three more times to make sure the inhaler is prepared for use.
How to use?
  1. Turn
  • Hold the inhaler upright with the aqua cap closed
  • Turn the clear base in the direction of the red arrows on the label until it clicks (half a turn)
  1. Open
  • Open the cap until it snaps fully open
  • Breathe out slowly and fully and then close your lips around the end of the mouthpiece
  • Point the inhaler to the back of the throat
  1. Press
  • When taking in a slow, deep breath through your mouth, press the dose release button and continue to breath in slowly for as long as you can
  • Hold your breath for 10 seconds or as long as it is comfortable
  • Close the aqua cap
  • Repeat step 1-3 for the second dose
Keynote

TOP - TURN, OPEN, PRESS

How to care and clean?

Clean the mouthpiece including metal part inside mouth pience with a damp cloth or dry tissue only, at least once a week.

Discard inhaler 3 months after inserting the cartridge even if you havent used all the medication

Special note
  • If the inhaler has not been used for more than 3 days, release one puff downward to prepare the inhaler for use
  • If the inhaler has not been used for more than 21 days, repeat the priming steps until a spray is visible and repeat for another three more times to prepare the inhaler for use
Available Brand in Malaysia

Spriva Respimat® (Tiotropium)

References

Product Information Leaflet

Description
  • Dry powder inhaler (DPI)
  • No coordination required
  • Comes with a dose indicator (Number 5 to 0 appear RED to warn you that there are only few doses left)
  • Device dispenses a small amount of very fine powder-like medication directly into the lungs
How to use?

Step 1 : Open

  • Hold the outer case with one hand and put the thumb of your other hand on the thumb grip
  • Push your thumb away from your as far as it will go

Step 2: Slide

  • SLIDE’ the lever on the side away from you, as far as it will go- until it clicks (Now ready for use)
  • Breathe out as far as you comfortably can, away from the device

Step 3: Inhale

  • Put mouthpiece gently between your lips and breathe in forcefully and deeply (not through your nose)
  • Remove the device from your mouth
  • Hold your breath for about 10 seconds or as long as you comfortably can. Then breathe out slowly

Step 4 : Close

  • You can now close the device by putting your thumb in the thumbgrip again and sliding it back towards you, as far as it will go
  • When you close the device, it clicks shut. The lever will automatically returns to its original position and is reset
  • Repeat if more than one dose is required (Repeat step 1-4)

Step 5 : Rinse your mouth with water

Keynote

OPEN, SLIDE, INHALE, CLOSE

How to care and clean?

Wipe the inhaler with clean, dry tissue. Do not wash any part of the Accuhaler

Special note
  • May not feel or taste anything during or after inhalation
  • Only slide the lever when you are ready to take a dose
  • Never breathe into your device
Available Brand in Malaysia (Full list may not be displayed here)

Seretide® Accuhaler (Salmeterol/Fluticasone)

Reference

Product Information Leaflet, Handling of inhaler devices, A Practical Guide for Pharmacists (1st ed), Pharmaceutical Services Division, MOH, 2010

Description
  • Inhalation powder
  • Comes with a dose indicator (It counts down with 1 each time you open the cover, when fewer than 10 doses are left, half of the dose counter shows red and after you have used last dose, half of the dose counter shows red and the number ‘0’ is displayed)
How to use?

Step 1 : Open

  • Open the cover when ready to take a dose
  • Do not shake the inhaler
  • Slide the cover until you hear a ‘click’ (Now ready for use)

Step 2 : Inhale

  • Hold the inhaler away from mouth and breathe out as far as is comfortable
  • Do not block the air-vents with your fingers
  • Put mouthpiece gently between your lips and breathe in forcefully and deeply (not through your nose)
  • Remove inhaler from your mouth
  • Hold your breath for about 10 seconds or as long as you comfortably can and then breathe out slowly

Step 3: Close

  • Slide the cover upwards as far as it will go to cover the mouth piece

Step 4 : Rinse your mouth with water

Keynote

Open, Inhale, Close

How to care and clean?

Use a dry tissue before closing the cover

Available Brand in Malaysia (Full list may not be displayed here)

Revlar Ellipta® (Fluticasone furoate/Vilanterol)

Anoro Ellipta®

Reference

Product Information Leaflet

Description
  • Medication is stored under pressure in the metal canister
  • A fine mist of medication is released upon pressing the canister that can be inhaled into the lungs
  • Works well with chamber or spacer
Priming (Using it for the first time only)

Press the canister in mid-air until an even spray is obtained

How to use?

Step 1:

  • Remove the mouth piece cover and hold the inhaler in upright position.
  • Stand or sit upright position when inhaling

Step 2:

  • Shake for 3 to 5 times in an up-down motion before each puff to mix the contents in the canister
  • Breathe out slowly through your mouth, away from the mouthpiece

Step 3:

  • Place the mouthpiece gently between teeth, without biting. Ensure a tight seal of the lips around the mouthpiece
  • Place index finger on the upper part of the inhaler and thumb at the lower part

Step 4:

  • Begin breathing in slowly and deeply through your mouth and at the same time press down firmly on the canister once
  • Continue to breathe in for 3 to 5 seconds until the lungs are full

Step 5:

  • Hold your breath for about 10 seconds or as long as comfortable
  • Do not REMOVE the inhaler away from the mouth while holding the breath

Step 6:

  • Remove the inhaler from mouth and breathe out slowly
  • Wait about 30 seconds and repeat step 2 to 6 for the subsequent puff

Step 7:

  • Replace cover and keep the inhaler
  • Rinse your mouth with water (for steroid-containing inhaler)
How to care and clean?
  • Keep in cool dry place
  • Remove metal canister and clean only the plastic container once a week by running tap water from one end for 30 seconds and repeat from the other end. Let it air dry
Available Brand in Malaysia (Full list may not be displayed here)

Ventolin® MDI (Salbutamol)

Flixotide MDI (Fluticasone)

Flutiform® MDI (Fluticasone/Formoterol)

Foster®  MDI (Beclometasone/Formoterol)

Alvesco® MDI (Ciclosonide)

Reference

Product Information Leaflet, Handling of inhaler devices, A Practical Guide for Pharmacists (1st ed), Pharmaceutical Services Division, MOH, 2010