I'm a domicilary carer (and asthmatic) with an 86 year old client who has recently been prescribed an Ivax Easi-breathe (salamol). She can't use a metered dose inhaler as arthritis means she cant push down on the canister, so that rules out spacers too. Shas COPD and finds it difficult to breath in deeply. I'm not sure she is getting much of the medication in using this device. While being treated in hospital for pneumonia last year she recalls having a once a day nebuliser. Does anyone know if there are long acting relievers that can be taken this way? With carers visiting daily they would be able to assist her with a once (or twice) a day nebuliser but not 4 hourly. PS She already takes oral steroids for the rheumatoid arthritis which is, I presume, why she has not been prescribed an inhaler corticosteroid just a reliever.
nebs are possible but something you or she needs to discuss with the docs.
but this from the AUK site
If you have arthritis in your hand, or have difficulty holding the inhaler, a device like the Haleraid or Turboaid might be useful. The Haleraid fits onto some spray-type inhalers. It allows you to release medicines by applying pressure with the palm of your hand. This can be easier than pressing the canister down. Your doctor or asthma nurse will be able to advise you. The Haleraid is not available on prescription, but your pharmacist can order it direct from the manufacturers, Allen & Hanburys. Your pharmacist can also order the Turboaid from the manufacturers, Astra Zeneca.
Hi Woody
Thanks for your quick reply. The Living Made Easy website suggests the Haleraid has been discontinued. Not sure how up to date it is. I think she would be able to activate a turbohaler without an add on aid if it was one where you just took the cover off and twisted the base. But it's getting a breath out followed by a good deep breath in that is beyond her. At least with a nebuliser all you do is breathe normally. If the nurse practitioner who visits her (she doesn't have an asthma nurse she has COPD) recommends a switch to nebulisers that would be a better option for her breathing restrictions. But not a better option if she needs someone to set it going for her every 4 hours as she only has carers morning and evening. That's why I wondered if there was a long acting reliever (like, say, formoterol fumarate) that can be taken via a nebuliser only once or twice a day instead of 4 hourly. I've not heard of one, has anyone else!
As far as I know the hailer aid has been discontinued but some may still be floating around somewhere.
I had a customer who was like your lady, with COPD and weak hands, he did have O2 at home but used accuhalers for all his meds. I don't like the easi-breath as they require lung effort, but accu and evo are self powered devices.
The accuhalers are dry powder fired into the mouth so she may be able to use those easier. You're thinking on Symbicort, she may be OK with that as well.
The Easi breathe she has is giving her salbutamol. My son used an accuhaler for a while. I remember it had a counter which was great, and was easy to handle and use, but still needs a breath out and deep breath in (as per the patient leaflet)?
I don't think I've seen an evohaler, but the images on the internet look like an ordinary metered dose inhaler that needs a firm press on the canister. Am I wrong?
I'll suggest she asks about Salmeterol. I assume the nurse started her on salbutamol as it's not common to go straight onto a long acting reliever until someone has been tried on the more common first line treatment of good old Ventolin to see if relievers actually have any benefit.
The Easi breathe is a breath activated device, but the evohaler/MDI (same thing just different names)and the accuhaler and the turbohaler (symbicort) do still require an in-breath but not to make the devices work only to breath in the contents.
Salmeterol is usually given with ICS, but as your friend is on oral steroids than as far as I can see that should be OK.
Some things that are being over looked are liquids and tablets, there are liquid versions of some drugs that while not widely used can be of benefit. Something to explore with the docs.
The management, treatment and long term outcomes for COPD and Asthma differ, while they both use mostly the same drugs their use and expectations differ. As far as I know COPD is generally regarded as a progressive disease and the aim is to slow it down, where's asthma it isn't a progressive and you can get significant improvements with the correct treatments for many. I know there are numbers on here and else where who don't fall into that category though.
Hi Woody
I’ve had my own asthma review today with specialist nurse at my GP, so I took the opportunity to ask what device she would recommend to someone elderly with COPD. She said an accuhaler and, like you, would avoid the Easi breathe.
I then went to do my evening shift with my COPD client and suggested that when the nurse who prescribed the Easi breathe visits her next week she ask to try an accuhaler instead. My client says she doesn’t feel as though she is properly breathing all the drug in via the Easi breathe, so it will be interesting to see if she manages to switch. Many thanks. I use a turbohaler and took mine along to see if she could take the cover off, which she could, and manage to twist the base (which she thought she probably could but didn’t as I wasn’t due to take a dose myself!)
Apparently in our PCT there is a new appointment starting April 1st of a home visiting respiratory nurse, so I’ve suggested she ask her GP for a referral.
the easi breath devices have their place in allowing people who find it difficult to co-ordinate the process, but in reality they are not ideal for those with poor lung function. The best option and research backs this up is a pMDI and Spacer, but the DPI inhalers are a good choice, and like I already said a customer of mine with COPD used those.
Mode of Action my mother is only 50 and she has to be nebulisered twice a day with salmetarol. This is a logn acting refliever that is only taken twice a day and is used along side a preventor. My mother has her preventor through the nebuliser too but I can't remember which one this is. Will check with her. She also has COPD and has her medication through the nebuliser because of post strock weakness she can't spray the inhalers even with a spacer to control the medication going in at her own rate. She also has the easi-breathe but this makes her gag as the spray comes out to fast for her. Will find out though which preventor it is she has through the neb and weither it is through the hospital she gets these or from her GP as she is under a respiratory specalist at the hospital
Hi 'Asthma family'
It looks like salmeterol is the first course of action for long lasting relievers. I'll keep a note of your reply. Thanks.
I think it's unlikely the GP practice nurse will recommend this as she's not an asthma or COPD specialist. At the moment we are pushing for a proper respiratory assessment (my client had one done as an hospital outpatient last year but they 'lost' the results and it's taken til now to get the GP to suggest another one!) and hopefully after that she will get either a nebuliser or maybe some O2 at home. Having struggled for a year with no medication at all she is now totally dependent on the salbutamol, but it doesn't last 4 hours and she takes 8 puffs a day already, after only a month. No inhaled 'preventer' has been prescribed, most likely because she already takes oral steroids for rheumatoid arthritis.
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