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. 2018 Sep 29;6(4):106. doi: 10.3390/pharmacy6040106

Table A1.

The inhaler instructions patients received for each inhaler in the educational videos, and the errors deemed critical for each inhaler.

Inhaler Instructions Errors measured
Diskus
  1. Open your Diskus: Hold it in the palm of your hand, put the thumb of your other hand on the thumb grip and push the thumb grip until it "clicks" into place.

  2. Load the Diskus by holding the device with the mouthpiece toward you. Slide the lever away from you as far as it will go to get your medication ready.

  3. Adjust your posture. Keep your shoulders down and head held high.

  4. Breathe out away from the device for as long as you feel comfortable.

  5. Place the mouthpiece gently in your mouth and close your lips around it.

  6. Breathe in deeply and evenly though the Diskus.

  7. Remove the device from your mouth.

  8. Hold your breath for 5-10 seconds.

  9. Calmly breath out through your nose.

  10. Close the Diskus by sliding the thumb grip toward you until you hear a “click.”

  1. Failure to open device

  2. Failure to hold device in right position

  3. Failure to empty lungs before inhalation

  4. Failure to load device

  5. Failure to hold breath at least 5-10 seconds after inhalation

  6. Exhalation into the mouthpiece

Easy-haler
  1. Open the protective cover.

  2. Insert the inhaler in a protective case. Make sure that the cover is on the mouthpiece.

  3. Remove the mouthpiece cover.

  4. Shake the inhaler vigorously up and down 3-5 times. Do not trigger the inhaler when shaking it!

  5. Hold the inhaler upright.

  6. Trigger the inhaler once until you hear a “click” and let the inhaler return to its original position.

  7. Keep holding the inhaler in an upright position.

  8. Breathe out normally.

  9. Place the mouthpiece in your mouth between your teeth and close your lips tightly around the mouthpiece.

  10. Breathe in through your mouth forcefully and deeply. Take the mouthpiece out of your mouth.

  11. Hold your breath for at least 5 seconds and then breathe out through your nose.

  12. Close the protective cover.

  1. Failure to open device

  2. Failure to hold device in right position

  3. Failure to empty lungs before inhalation

  4. Failure to load device
    • -
      Failure to shake device
    • -
      Failure to press button
    • -
      Loading in wrong order
    • -
      Triggering inhaler when shaking it
  5. Failure to hold breath at least 5 seconds after inhalation

  6. Exhalation into the mouthpiece

Ellipta
  • 1.

    Wait to open the cover until you are ready to take your dose. Do not shake the inhaler.

  • 2.

    Slide the cover down to expose the mouthpiece. You should hear a “click.”

  • 3.

    Breathe out away from the device for as long as you feel comfortable. Hold the inhaler away from your mouth - do not breathe out into the mouthpiece.

  • 4.

    Put the mouthpiece between your lips, and close your lips firmly around it. Do not block the air vent with your fingers.

  • 5.

    Take one long, steady, deep breath in through your mouth.

  • 6.

    Hold your breath for at least 3-4 seconds.

  • 7.

    Remove the inhaler from your mouth. Breathe out slowly and gently.

  • 13.

    Slide the cover upward as far as it will go, to cover the mouthpiece.

  • 1.

    Failure to open/load device

  • 2.

    Failure to hold device in right position

  • 3.

    Failure to empty lungs before inhalation

  • 4.

    Failure to hold breath at least 3-4 seconds after inhalation

  • 5.

    Holding fingers on air vents

  • 7.

    Exhalation into the mouthpiece

Turbu-haler
  1. Unscrew the cap and take it off. Hold the inhaler upright.

  2. Twist the grip of your Turbuhaler as far as it will go. Then twist it all the way back. When twisting you will hear a "click."

  3. Breathe out deeply away from the device.

  4. Put the mouthpiece between your teeth, and close your lips around it.

  5. Breathe in forcefully and deeply through your mouth.

  6. Remove the Turbuhaler from your mouth and calmly breathe out through the nose.

  7. Replace the cap.

  1. Failure to open device

  2. Failure to hold device in right position

  3. Failure to empty lungs before inhalation

  4. Failure to load device

  5. Failure to breathe out through the nose after inhalation

  6. Exhalation into the mouthpiece

Source: [13,25,36,38,39,40].