Hi all,
Just wanted a bit of advice please and this is usually the best place to come!
I am currently on Fostair and Qvar, 2 puffs 3 times daily.
My cons has just added in Tilae / Nedocromil Inhaler, 2 puffs, 4 times a day.
I took it for the first time this morning but it is such a strong puff of medicine that firstly it made me choke, then secondly, it takes foul and made me gag!
Has anyone else has similar issues?
Thanks
Hev x
not one that gets much mention on here, so don't know much about it, but try using a spacer. I do recall the odd mention that it wont fit normal volumatic spacers. Google the spacer, you should be able to buy one online.
Method of Administration
If the inhaler is new, it should be primed by actuating 4 times prior to inhalation. If not used for more than 3 days, additional priming with 1-2 actuations is advised.
The inhaler should be well shaken and the dustcap removed. The mouthpiece of the inhaler should be placed in the mouth and the lips closed around it prior to the patient beginning to breathe in. The patient should then be instructed to breathe in slowly and deeply through the mouth and as inhalation begins the aerosol should be actuated by pressing the can down firmly with the first finger whilst continuing to breathe in. The breath should then be held for 10 seconds before exhaling into the air. To avoid condensation of moisture in the inhaler and blocking of the spray, exhalation through the inhaler should be avoided. If the patient needs two actuations they should be instructed to wait for about one minute before repeating the inhalation procedure. The dustcap should be replaced following use. To prevent excessive accumulation of powder the plastic body and mouthpiece cover should be rinsed in hand hot water twice a week and then thoroughly dried. If the Fisonair holding chamber is used this also should be washed in hand hot water twice a week and thoroughly dried.
Children and patients with difficulty in coordinating actuation of the inhaler with inhalation of the aerosol cloud, may benefit from using a holding chamber to assist inhalation of the medication. When using a holding chamber the procedure for inhalation is different from that through the standard mouthpiece. The medication is first released into the holding chamber from which it is subsequently inhaled (in one or more breaths) until the chamber is empty. Thus, there is no need to co-ordinate actuation of the inhaler with simultaneous breathing. However medication must still be inhaled slowly and deeply from the holding chamber. The standard mouthpiece, is suitable for use with large volume holding chambers such as Fisonair.
Detailed instructions for the inhalation of Tilade CFC-Free from each of the three devices are provided in the respective Patient Information Leaflet supplied with each pack.
Hev, try tilting your head back slightly and start breathing in just before pressing the inhaler. I use Intal which is similar - the puff is quite large and timing it better ensures less of it is deposited in your mouth.
Unfortunately the Fisonair spacer has become extinct, but in Australia a small mouthpiece adaptor is available that allows a Tilade inhaler to fit onto a Volumatic. Not sure if an alternative large volume spacer is available for Tilade here - but you could ask your consultant.
interesting as page 6 of this tinyurl.com/yg5pk3e says always use a spacer
and this is a US patent for a spacer, tinyurl.com/yj64gnf not sure if it's available though
Hi Hev
Tilade was disgusting that the only way I would take it years ago is using the ""Mint"" Tilade Inhaler, though to be honest that wasn't much better. Ask if it is still available.
I'm sort of on/off this inhaler. I agree it's not very nice at all... try spraying it into a spacer then spraying in some ventolin straight after, I know there is probable some medication loss but that's the only way I can take it.
Em x
perhaps someone can confirm this, but doesn't the aerochamber plus spacer come with a flexible connection, would that be an option? The instructions look like it's a universal type fit.
Thanks for your help, it is much appreciated!
I am trying to persevere with it.
Woody-som, thanks for the mention of the aerochamber plus. I have a very old one of these, must be 7 years old by now and it is very cloudy but does work and it has made it easier to take.
I can't remember where I got it from though and asked at a couple of pharmacies earlier but they don't it. I think I might have to google it and see if I can get a new one!
Thanks again
Hev
Hi Hev,
Please ask your consultant if Tilade is suitable for use with an AeroChamber.
The information in Woody-som's first post in this thread states that a *large volume* holding chamber such as the Fisonair should be used with Tilade.
I looked into this a while ago (I was looking for a spacer to use with Intal) and research seems to suggest that with the old CFC versions of Tilade and Intal the fine particle mass that is inhaled can be increased or decreased depending on the type of spacer used. Using a large volume spacer such as the Fisonair, Nebuhaler or Volumatic *increases* the number of fine particles inhaled, whereas using a small volume inhaler *decreases* it (resulting in less medication inhaled compared to using a MDI alone). Having tried using Intal with an Aerochamber it does seem be be more effective to use the inhaler alone in terms of being less symptomatic.
A compromise might be to try increasing the number of puffs using the Aerochamber if 2 puffs four times a day doesn't work (Tilade costs £39.94 for one inhaler so probably only sensible if it's the only way you can take it). Alternatively spraying the inhaler placed against the port of a Volumatic might be okay as not very much medication would be lost as Me suggests below.
Hope that helps,
Ginny
Ginny makes a very good point about checking the use of the spacer. Different designs do produce different results regarding how much medication you get. The large volumatic etc are shown to increase effectiveness of inhaled medications.
The aerochamber was at one stage introduced and replaced the volumatic as this was also removed from sale, but has been brought back. Not sure why, but do check if you find the aerochamber helps that it's OK.
The CFC free tilade is different though, i notice that the inhaler has to be cleaned at least twice a week to prevent blocking. I also thought last year that it was no longer manufactured, obviously that is no longer the case.
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