Home' Australian Pharmacist : Australian Pharmacist September 2016 Contents Australian Pharmacist September 2016 I ©Pharmaceutical Society of Australia Ltd.
CONTINUING PROFESSIONAL DEVELOPMENT
1. Asthma is a condition characterised
by chronic inflammation and
reversible airway obstruction. Which
ONE of the following devices would
NOT be recommended to a patient
only diagnosed with asthma?
2. Chronic obstructive pulmonary
disease (COPD) is a progressive
condition that can worsen as a
patient ages. Which ONE of the
following statements regarding
treatment of COPD is CORRECT?
a) Technique and maintenance of inhaler
devices is not an important factor in
b) Correct technique of inhaled medicines
exacerbates symptoms of COPD.
c) Some dry powder devices require a
large inspiratory force, which may not be
achieved by patients in advanced COPD.
d) Elderly patients do not require regular
reinforcement of their inhaler technique
as they have a lot of experience with
3. Many dry powder inhalers (DPIs) are
available as capsules that are loaded
into inhalation devices. Which ONE of
the following is INCORRECT?
a) HandiHaler devices can become caked
with powder if not regularly replaced.
b) An advantage of dry powder inhalations
is that the force of inhalation is all that is
required for aerosolisation of the dose.
c) Medicines delivered through capsule
inhalers have different particle sizes.
d) If a patient is unsure whether they have
pierced a capsule that has been loaded
into an inhalation device, they should
attempt to pierce it multiple times,
as they should not open the device
to confirm whether there are holes in
4. Which of the following resources are
available to pharmacists to assess
inhaler technique and adherence of
b) Asthma Score.
c) GuildCare Inhaler Technique Check.
d) All of the above.
1. Deloitte Access Economics. The Hidden Cost of Asthma:
Asthma Australia and National Asthma Council Australia;
2015. At: www.asthmaaustralia.org.au/news/national/new-
2. Australian Institute of Health and Welfare. Asthma. 2016. At:
3. Bateman ED, Hurd SS, Barnes PJ, et al. Global strategy for
asthma management and prevention: GINA executive
summary. Eur Respir J 2008;31(1):143–78. At: http://erj.
4. Inhaler Error Steering Committee, Price D, Bosnic-
Anticevich S, Briggs A, et al. Inhaler competence in asthma:
common errors, barriers to use and recommended
solutions. Respir Med 2013;107(1):37–46. At: www.
5. Australian Institute of Health and Welfare. COPD — chronic
obstructive pulmonary disease. 2016. At: www.aihw.gov.
6. National Asthma Council Australia. How-to videos. 2016.
7. Lung Foundation Australia. Inhaler device technique. At:
Poor maintenance and cleaning
Some devices are prone to clogging;
especially those that see repeated
use. Devices for inhaled cromones are
well known for clogging due to the
propellant/active ingredient mix, while
HandiHalers can become caked with
powder if not regularly replaced. Spacers
are also prone to poor maintenance.
Medicines delivered via capsule inhalers
have different particle sizes. Each
device is designed to aerosolise specific
medicines. Putting a capsule into the
wrong device can impact on the delivery
and deposition into the lung.
Piercing a capsule multiple times
Dry powder capsules are pierced prior
to inhalation by the device. If a patient
pierces the capsule multiple times, this
can cause the capsule to fragment,
impacting on delivery of the powder
inside. If a patient is unsure if they have
pierced the capsule, they can open the
device and confirm if holes are present
in the capsule.
Inhaling dry powder capsules
with a single breath
Dry powder inhalations have an
advantage over aerosols in that the force
of inhalation is all that is required for
aerosolisation of the dose. Patients should
use multiple inhalations per activation to
ensure they have received the entire dose.
Correct technique of inhaled medicines
maximises the treatment of asthma,
and minimises the symptoms of COPD.
Pharmacists have a role in regularly
checking inhaler use, demonstrating the
correct technique, and providing verbal
and written instructions.
Elderly people, children and patients
with a disability are at high risk of
misuse of inhalers.
After counselling the patient on correct
inhaler technique, his asthma control
stabilises. His doctor is now considering
a step-down approach to find the
minimum effective dose, while still
maintaining control of symptoms.
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