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CONTINUING PROFESSIONAL DEVELOPMENT
Inhaler devices in Australia
There are multiple inhalation devices
available on the Australian market for
respiratory conditions; some are utilised
for both asthma and COPD, while others
are specifically indicated for COPD only.
The medicine delivered, rather than the
device itself, determines this indication.
It is important for pharmacists to
familiarise themselves with the
pharmacology of the medicines
available for each condition – with many
brands available that combine multiple
agents into one device (e.g. long-acting
beta-agonists, long-acting muscarinic
antagonists, and corticosteroids),
there is the potential for patients to
be inadvertently prescribed multiple
agents from the same class.
In addition to the inhalation devices
listed in Table 2, pharmacists should
familiarise themselves with the correct
operation of spacers, nebulisers,
and associated equipment.
Accessories for improving
delivery of inhaled medicines
Spacer devices are an important tool
for improving delivery of medicines
from pressurised metered dose inhalers
(pMDIs). Care and correct operation of a
spacer device is as critical to the delivery
of an accurate dose as the care and
correct operation of the inhaler device.
Resources to aid with
Step-by-step instructions are available
for the listed devices, and should be
utilised when counselling a patient with
regards to their medicines. The National
Asthma Council Australia6 and The Lung
Foundation7 have videos demonstrating
inhaler technique that are excellent
tools. Pharmacists can use these to
familiarise themselves with the correct
technique, and they can be utilised in a
one-on-one counselling session with a
patient in a private consultation room.
The Pharmaceutical Society of Australia
(PSA) has Self Care Fact Cards on Asthma
and Asthma medicines that can be used
in patient counselling.
Technique and inspiratory
Some patient groups may require
regular reinforcement of their
technique, including children, the
elderly, and people with a disability.
In addition, all patients who require
an inhaled medicine will benefit from
regular review and practice of their
While the above resources are valuable,
there are a number of factors that can
contribute to poor technique and device
failure. Being able to identify these is
critical to effective patient counselling.
Mistiming the steps in operating
The steps required to operate each
device are important. While patients
may always remember to remove a
dust cap before inhaling a dose, they
may forget to shake an aerosol, or to
pierce a dry powder capsule device.
For some devices the patient needs
to coordinate inhalation with dose
delivery – this is often the source of
Attempting to deliver multiple
doses per inhalation
Aerosols are designed to deliver one
dose per activation. Attempting to
deliver two doses per inhalation
results in poor coordination of one or
both doses, and poor aerosolisation
of the second dose. The second dose
of all aerosol inhalations must involve
repeating the entire inhalation process.
Insufficient inspiratory force
Some dry powder devices require a
large inspiratory force, which cannot
be achieved by all patients (e.g. in
children, advanced COPD). An In-Check
DIAL or similar device can help assess
if a patient is capable of receiving the
Table 2. Inhaler devices available in Australia
Asthma and COPD
Pressurised metered dose inhalers
(pMDIs), including Rapihaler and Autohaler
It is important for pharmacists to familiarise themselves
with the pharmacology of the medicines available for each
condition – with many brands available that combine multiple
agents into one device (e.g. long-acting beta-agonists,
long-acting muscarinic antagonists, and corticosteroids),
there is the potential for patients to be inadvertently
prescribed multiple agents from the same class.
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