Development of a Teaching Service System for Using Inhaled Brochodilators in Patients with Respiratory Diseases*

Main Article Content

Supattra Khiawwan


                 Treatment of patients for respiratory diseases such as asthma and chronic obstructive pulmonary disease (COPD) are characterized by bronchoconstriction and airway inflammation. Hence treatment emphasizing on use of inhaled therapies particularly inhaled bronchodilators and corticosteroid. The bronchodilators improve lung expansion by allowing the more air move into the lungs. Apart of bronchodilators, inhaled corticosteroid reduces airway inflammation. Hence inhaled therapies both reduce symptoms and risk of exacerbation.Their major advantages of inhaled agents over oral agents are the higher effective drug delivery to specific site and the less systemic side effects. However, the concerned issues regarding the use of inhaled therapies are varieties inhaler devices available in clinical practice. In addition the inhaler techniques including breathing technique and inspiratory flow generated by patients are variable.For these reasons, Inhaler therapies preparation training are crucial for improving outcome. When the inspiratory flow is optimal, drug particles will be able to reach the distal airways and lungs effectively.The purpose of this article is to develop an effective inhalation technique training program for patients with respiratory diseases. The aim of training is that the patients are able to use the inhaler correctly. Healthcare providers have to be competent for teaching their respiratory patients. The article also focuses on three distinct areas of skill development or so-called 3M. Firstly, human development (Man or M1), this aspect emphasizes training medical personnel to be competent on training of inhaler device technique.The second aspect is to develop teaching materials and media (Material or M2). Last not least is aspect focusing on the development of evaluation criteria for assessing inhalation technique quality (Method or M3). In conclusions, 3M is development schema that is practical and applicable in real life clinical scenario. 




Download data is not yet available.

Article Details

How to Cite
Khiawwan S. Development of a Teaching Service System for Using Inhaled Brochodilators in Patients with Respiratory Diseases*. Rama Nurs J [Internet]. 2019Sep.13 [cited 2020Aug.9];25(2):148-65. Available from:


1. Broeders ME, Sanchis J, Levy ML, Crompton GK,
Dekhuijzen PR. The admit series—issues in inhalation
therapy. 2) Improving technique and clinical effectiveness.
Prim Care Respir J. 2009;18(2):76-82.

2. Ganderton D. General factors influencing drug delivery to
the lung. Respir med. 1997;91:13-6.

3. Pavia D. Efficacy and safety of inhalation therapy in chronic
obstructive pulmonary disease and asthma. Respirology
(Carlton, Vic). 1997;2:S5-10.

4. Newman SP. Production of radioaerosols. Aerosols and
the lung: clinical and experimental aspects: Butterworth
London; 1984. p. 71-91.

5. Capstick TG, Clifton IJ. Inhaler technique and training in
people with chronic obstructive pulmonary disease and
asthma. Expert Rev Respir Med. 2012;(1):91-101.

6. Brocklebank D, Ram F, Wright J, Barry P, Cates C, Davies
L, et al. Comparison of the effectiveness of inhaler devices
in asthma and chronic obstructive airways disease: a
systematic review of the literature. Health Technol Assess.

7. Newman S, Agnew J, Pavia D, Clarke S. Inhaled aerosols:
lung deposition and clinical applications. Clin Phys Physio
Meas. 1982;3(1):1-20.

8. Pedersen S, Hansen O, Fuglsang G. Influence of inspiratory
flow rate upon the effect of a turbuhaler. Arch Dis Child.

9. Ho SF, O’mahony MS, Steward JA,Breay P, Burr MC.
Inhaler technique in older people in the community. Age
Ageing. 2004;33(2):185-8.

10. Newman SP. Dry powder inhalers for optimal drug
delivery. Expert Opin Biol Ther. 2004;4(1):23-33.

11. Melani AS, Bonavia M, Cilenti V, Cinti C, Lodi M,
Martucci P, et al. Inhaler mishandling remains common
in real life and is associated with reduced disease control.
Respir Med. 2011;105(6):930-8.

12. Taddese F, Osada H. Process techno-innovation using
TQM in developing countries empirical study of deming
prize winners. J Technol Manag Innov. 2010;5(2):47-65.

13. Ishikawa K, Loftus JH. Introduction to quality control.
Tokyo: 3A Corporation; 1990.

14. Klijn SL, Hiligsmann M, Evers SM, Román-Rodríguez
M, van der Molen T, van Boven JF. Effectiveness and
success factors of educational inhaler technique
interventions in asthma & COPD patients: a systematic
review. NPJ Prim Care Respir Med. 2017;27(1):24.

15. Crompton G, Barnes P, Broeders M, Corrigan C, Corbetta
L, Dekhuijzen R, et al. The need to improve inhalation
technique in Europe: a report from the aerosol drug
management improvement team. Respir Med.

16. Bower L, Barnhart S, Betit P, Care AAFR. AARC Clinical
practice guideline: selection of an aerosol delivery device
for neonatal and pediatric patients. Respir Care.1995;4(12):1325-35.

17. Newman SP. Spacer devices for metered dose inhalers.
Clinical Pharmacokinetics. 2004;43(6):349-60.

18. Dalby R, Spallek M, Voshaar T. A review of the
development of respimat® soft mist™ inhaler. Int J Pharm.

19. Baddar S, Rawas Al O. Which device for which patient?
criteria for selecting inhaler devices. Eur Respiratory Soc;

20. Alagusundaram M, Deepthi N, Ramkanth S,
Angalaparameswari S, Saleem TM, Gnanaprakash K, et
al. Dry powder inhalers-an overview. Int J Res Pharm Sci.

21. Phanphao W, Jenghua S, Supamoon W, Nakham A.
Intervention on manageing drug related problems in
hospitalized patients with asthma and chronic obstructive
pulmonaly disease (COPD) in Buddachinnaraj Phitsanulok
Hospital. NUJST. 2013;13(1):51-9.

22. Panida K, Porntip M, Surakit N, Theerasuk K. Self-care
for medication use in older patient with chronic obstructive
pulmonary disease. Rama Nurs J 2013;17(2):287-304.

23. Global Strategy for Asthma Management and Prevention:
2016. [cited 2019 July 1]. Available from: https://www.

24. Interiano B, Guntupalli KK. Metered-dose inhalers: do
health care providers know what to teach? Arch Intern
Med. 1993;153(1):81-5.

25. Hanania NA, Wittman R, Kesten S, Chapman KR. Medical
personnel’s knowledge of and ability to use inhaling
devices: metered-dose inhalers, spacing chambers, and
breath-actuated dry powder inhalers. Chest.

26. Zainudin B, Sufarlan AW. Incorrect use of pressurised
metered dose inhaler by asthmatic patients. Med J Malasia

27. Aydemir Y. Assessment of the factors affecting the failure
to use inhaler devices before and after training. Respir
Med. 2015;109(4):451-8.

28. Evans M. US Department of Health and Human Services
Health Resources and Services Administration. 2011.

29. Sokovic M, Pavletic D, Pipan KK. Quality improvement
methodologies–PDCA cycle, RADAR matrix, DMAIC
and DFSS. JAMME. 2010;43(1):476-83.

30. Gupta S. How to ensure the correct inhaler device is selected
for each patient. Clin Pharmacist. 2009;1:322-3.

31. Davies BL, editor Development of evaluation measures:
promoting asthma control in children. The 17th
International Nursing Research Congress Focusing on
Evidence-Based Practice; 2006.