Just use appropriate pictures!!!

I really can’t believe its been a week since I got back to the UK and Healthevoices is over. I still can’t put into words how I feel about it. It was nothing I could ever imagine and really can’t put it in words. It was truly fantastic.

Before I settle to write about the HealtheVoices experience there is something that was posted recently which has really caused a lot of uproar.

Asthma hits the headlines for all the wrong reasons all the time. Normally it is the number of asthma deaths that are occurring hits the headlines which shockingly is at 3 every day in the UK and 11 in the US everyday. Way way to high for a condition that is fairly common but equally under funded.

One of the reasons given to the poor asthma death rate is poor asthma management and poor inhaler technique. There has been a massive push recently in primary care and secondary care to ensure that patients are taking their inhalers when they need to but not only when they need to we need to make sure they are being taken correctly. Unlike tablets which can only really betaken on way, or injections again which when subcutaneous you can’t go massively wrong however inhalers is a whole new board game. The sheer number of different types of inhalers then the need for multi tasking when taking them as you need to breath in, spray inhaler, then take it and hold your breath. There is not enough time given to assessing the type of inhaler which will be best for the patient and suit their needs. Especially the younger people and again older people due to dexterity issues. Even being young, fit and with it taking an inhaler correctly can be hard.

I like to think my inhaler technique is pretty good. I do and have been told on occasion that my technique specifically using my MDI (the traditional spray) inhaler is not quite right. I was even told at an asthma research meeting by one of the Dr’s there my technique was questionable but he said he let me away with it as I was about to go on stage to speak in front of about 150 people. But it shows that even those who can have good technique can slip when not concentrating 100% on what they are doing.

Asthma nurses, dr’s, patients and researchers on twitter were in uproar after the below photo was posted by the National Institute for Clinical Excellence (NICE).

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This picture is a complete 101 on how not to take your inhaler. Everything about it is wrong. Quite rightly everyone has been very annoyed by the main centre of excellence for health in the UK getting a photo so wrong. They have clearly not taken any time over selecting a picture or thought about the impression it is going to have on anyone that sees it.

This is not a new issue. Every week there are photos printed/posted relating to asthma which do not show good inhaler technique or even a technique which is relating to the current guidelines. It seems that everyone has their image bank and go to that, select a nice photo and that’s the one that is used.

I have and I am sure many others have come to the conclusion that the image banks have not been updated and are all out of date and not in keeping with current best practice.

As a result of this I have decided to try and make a change. I want to update these image banks and have a wide range of photos, some of older people using their inhaler, some younger people, a mix of devices as well but the key thing is to have the photos which display the current best practice.

I have been very fortunate to have so many people come forward to help with this so I am keen to get started. I have never done anything like this before but the hope is there will be more photos like the one below and zero photos appearing similar to the above.

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Inhaler Technique

This is something that I wouldn’t say bugs me but it is a gripe.

When I go to have my asthma review with my health centre (which I think is a waste of time- because not wanting to be big headed but I end up teaching them more about asthma than they tell me!!!) But to the point. They always tick on their sheet that they have done the inhaler technique review. I have never once been asked to show them my inhaler technique. I think it is possible that they think that because I have taken them for so long I must know how to take them. But is think that the longer you take them the more your inhaler technique should be reviewed as you are likely to develop bad habits. When I think about it, it is not only at my health centre the hospital do it as well. There have been so many times i ahve seen such bad techniques and jsut want to go and tell people that they doing it wrong and how to do it but i always refrain.

Here are some of the techniques I have seen!

1) giving it a good shake then holding it about5 inches from your mouth and squirt and try and catch it (no joke catch it. the person head moved forward as though they were catching somethign in their mouth!!!)

2) a good shake given again and holding the inhaler jsut outside an open mouth and giving four puffs and keeping ones mouth open and i could see the inhaler mist out the side (well not mist but you know when you can see inhaler when you spray it!)

3) a good shake and the inhaler held upside down and puffed into the mouth. the mouth was closed but immediatly opened after the puff.

4) the inhaler is sprayed as the person is breathing out! so it came out the top!!!

These are just a few of the different inhaler techniques I have seen. I always have tried to make sure myinhaler technique is right. I know it probably isn’t and I have probably developed bad habits but I’m only human. You cant blame people for having bad inhaler techniques because if others experiences are the same as mine then you don’t get taught how to have a good technique and what is a bad technique.

I know it is difficult to know the right way and wrong way for all the inhalers. I have three different types of inhaler and all have different techniques of using it which is a bit confusing and when your in a rush you don’t always have time to stand and breathe out deeply and then in and take inhaler and hold your breath and then repeat this if you have a few puffs to do etc.

This is a pic I found on the internet when looking for different inhaler devices as there are so many but i think its quite a good poster!

Peak flow is also another one as results can vary hugely depending on your technique. Also I haven’t seen random techniques for this as you don’t tend to do a peak flow on the bus or up town shopping!!!!

I know there are some followers of this blog from other countries and wondered what you healthcare providers are like with inhaler techniques and things?