DEVICES AEROCHAMBERS [ SPACERS ] Purpose : 1- Used with MDIs to keep the medication in suspension for few seconds until

l you breathe it in [ slow the delivery of the medication], make it easier to reach the lungs, and less medication gets deposited in the mouth & throat, lessening the irritation and oral thrush with inhaled COCS Not used with powder inhalers. Use : 1- Uncap the spacer 2- Shake the inhaler well and uncap it 3- Put the inhaler in the spacer [ flexible end ] 4- Breathe out away from the spacer 5- Place the mouth piece in your mouth [ rigid end ] 6- Press the top of your inhaler once 7- Breathe in very slowly until you have a full breath. If you hear a whistle sound, you are breathing too fast [ some spacers have this feature ] 8- Hold your breath for 10 seconds then breathe out 9- If you need another dose of the same or other medication, wait 1-2 minutes between doses 10- When helping someone use a spacer[ child ], ask the person to breathe normally into the spacer, as you squeeze the inhaler to release the dose. Then let the person inhale and exhale into the spacer for few breaths Cleaning : Take the spacer apart, wash with mild soap and warm water, let it air dry [ overnight ], dont wipe it with cloth [ causes static ] Spacers should be replaced every 12 months or so.

METERED DOSE INHALERS [ pMDI ] 1- The 1st time use or if not used for more than 14 days, prime the inhaler until firm spray comes out [this step depends on the manufacturer ] 2- Shake the inhaler several times and uncap it 3- Breathe out away from you inhaler 4- Hold the inhaler upright [ canister up ], place the mouth piece in your mouth, with your tongue flattened close your mouth around it, tilt your head back slightly. 5- As you breathe in slowly and deeply, press the top of the inhaler to release the dose, keep breathing until you have a full breath. 6- Remove the inhaler from your mouth and hold your breath for 10 seconds or as you can. 7- Breathe out slowly 8- If you need a 2nd puff, wait 30 seconds between puffs [Alvisco : no shaking or waiting between puffs ] 9- Recap your inhaler after each use 10- Record the number of doses 11- Keep the inhaler wherever you go [ a rescue medication ] Cleaning : Remove the metal canister by pulling it out Clean the plastic parts with mild soap and water, let air dry [ overnight ] Never wash the metal canister or put it in water ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, DISKUS INHALER It is a dry-powder inhaler, delivers the medication to your lung helped by the force of your indrawn breath, has no propellant [ unlike pMDI ]. It has a built-in counter, so that you know how many doses are left 1- Hold the device in the palm of one hand, put the thumb of the other hand on the thumb grip and push the thumb grip until it clicks into place.[ no shaking ] 2- Slide the lever as far as it will go, until you hear a click, now your dose is loaded. 3- Breathe out away from the device 4- Place the mouth piece in your mouth and seal the lips around it 5- Breathe in deeply until you have taken a full breath 6- Remove the Diskus from your mouth and hold your breath for 10 sec. or as you can, then breathe out 7- If you need another dose wait 1 min. 8- Close the Diskus by sliding back on the thumb grip [ the lever will return to its original position ] 9- Always check the number in the dose counter window to see how many doses are left. 10- If you drop your Diskus or breathe into it after its dose has been loaded, the dose may be lost, reload the dose. 11- You can use a dry cloth to wipe the mouth piece but never use water.

TURBUHALER It is a dry powder inhaler delivers the medication to you lungs, helped by the force of your indrawn breath. Contains no propellant [ contrary to pMDI ] 1- Unscrew and remove the cover 2- Hold the inhaler upright and turn the colored grip as far as it will go towards the right and back until you hear a click. 1st time use you may need to do this the number determined by the manufacturer [ priming ] 3- Load the dose as step 2 , one time only 4- Breathe out away from the device 5- Place the mouth piece in your mouth, seal lips around it 6- Breathe in forcefully and deeply , normally you dont taste the powder or feel it [ small mount ] 7- Remove the Turbuhaler from your mouth, hold your breath for 10 sec. or as you can, breathe out 8- If you need another dose, wait 1 min. 9- If you dropped your turbuhaler or breathed into it after loading the dose, you may lost your dose, reload the dose again 10- Replace the cover back, you can clean your it by wiping the mouth piece with a dry cloth, never use water. 11- Always the check the number in the side counter window to see how many doses are left ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,

HANDIHALER [ SPIRIVA COUNSELING ] Tiotropium bromide is long acting [24h ] bronchodilator for maintenance treatment of COPD, it makes breathing easier by opening your narrowed airways and keep them open for 24h. - COPD : a progressive narrowing of the airways, leading to breathing difficulties [ usually resulting from many years of cigarette smoking as well as genetic predisposition ], smoking cessation will slow this progression . - Contains lactose [ which contains milk protein ] - Not in : Allergy to the medication or lactose / glaucoma - Caution : difficult urination / enlarged prostate - It is not a rescue medication - Use : 1- Capsules for inhalation, dont swallow 2- One capsule for inhalation once daily preferably at the same time 3- Release the dust cap by pressing the green piercing button 4- Open the dust cap completely by pulling it upwards, then open the mouth piece by pulling it upwards 5- Blister handling : a- the blister card contains 2 blister strips joined along a perforated line. Separate the blister strips by tearing along the perforation. b- Peel the back foil until one capsule is fully visible [ you must use the in-use strip in 5 days ] c- Remove that capsule. If any other capsules exposed discard them 6- Place the capsule in the centre chamber [ no matter with which end ] 7- Close the mouth piece firmly until you hear a click, leaving the dust cap open 8- While holding the handihaler upright, press the piercing button completely and only once and release [ makes holes in the capsule and allows the medication to release when you breathe in ] 9- If your chest is congested with mucus, try to cough to clear your lungs, breathe out completely away from the mouth piece 10- Raise the handihaler to your mouth and close your lips tightly around the mouth piece, while your head in upright position and breathe in slowly and deeply at a rate sufficient to feel the capsule vibrates. Have a full breath, hold your breath as you can [ try count to 10 ] at the same time remove the handihaler out of your mouth, resume normal breathing. 11- Repeat step 10 once again to ensure complete inhalation of the capsule contents 12- Open the mouth piece, tip out the used capsule and dispose, dont touch it , if something of the powder gets in your hands wash your hands thoroughly 13- Close the mouth piece and the dust cap. Cleaning : Clean it once a month as follows : 1- Open the dust cap and mouth piece. Open the base by lifting the piercing button 2- Rinse the whole handihaler with warm water to remove any powder

3- Tip any excess water, while parts left opened, let it air dry [ 24h ] 4- The outside of the mouth piece may be cleaned by a moist but not wet tissue if needed. Dont place the handihaler in the dishwasher Common S/E : dry mouth, bad taste usually mild, suck candy or rinse your mouth Stop the medication and contact your Dr. if you experience : allergic reactions [ hives, SOB, chest tightness,,,] / difficult urination / irregular heart beats ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, PEAK FLOW METER Function : It measures how fast and hard you can blow out air from your lungs[ peak expiratory flow PEF ], it determines lung function. Whether your asthma is controlled or need more treatment. Considered useful in selected patients, should be used along with symptoms as a monitoring guide [ Limitations : not suitable in less than 6 Y / cough can give false reading ] - USE : 1- Set the meter indicator to zero 2- Sit or stand in upright position 3- Take a deep breath 4- Seal the lips around the mouth piece and expire air as hard and as fast as you can. Take the reading 5- Repeat 2 more times, each time you set the indicator to zero. Take the highest reading 6- Keep dairy record of your reading to show to your Dr. 7- Cleaning : by warm water for 5 minutes, let it air dry, the mouth piece can be removed and cleaned separately. Peak Flow measurements are classified into 3 zones of measurement : 1- Green zone : the PEF is >= 80% of the normal measure asthma is controlled 2- Yellow zone : the PEF is 50-79% of the normal uncontrolled, need medication 3- Red zone : the PEF is < 50% of the normal need ER ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,

EpiPen [ Epinephrine ] For emergency treatment of Anaphylaxis and to carried by people at risk of serious allergic reactions or history of anaphylactic reactions. - The allergen triggers the release of chemicals which can lead to life-threatening symptoms [ hives & swelling / swelling of throat, lips, tongue / difficulty breathing or swallowing / generalized flushing & itching / increased heartbeats / low Bp / overwhelming sense of doom/ collapse & loss of conscience . - It may occur due to insect bites / foods e.g. peanuts, shelfish, fish, milk,,, - Role of EP : relaxes the muscles of the airway, so you can breathe easily / help reverse the rapid decrease in your Bp / relax the muscles in the stomach, intestine and bladder / relieve the swelling, itching - Supplied : disposable prefilled automatic injection of : 1- EpiPen : unidose 0.3mg Ep autoinjector 2- EpiPen Jr : unidose 0.15 Ep autoinjector Caution : high Bp / irregular heartbeats / DM / thyroid conditions / narrow angle glaucoma [ it remains essential even with these conditions ] - Proper use : 1- Carry with you the EpiPen all times 2- Dose : - The 0.3 mg for adults & children >= 30 kg - The EpiPen Jr 0.15mg for children 15-30 kg - Children < 15 Kg call 911 3- Never touch or push the orange tip where the needle comes out, dont remove the blue safety release until ready to use 4- If you have only an expired unit, use it , it is an emergency and call 911 5- Flip open the cap on the carrier tube [ yellow on EpiPen and Green on EpiPen Jr ], tip the carrier tube and slide the EpiPen out of the tube 6- Grasp the EpiPen form a fist around the unit [ with orange tip down ], pull of the blue safety release 7- Swing and push orange tip firmly into the outer thigh so it clicks and hold for several seconds. Inject even through closing if necessary 8- Remove the unit, massage the area, Note : the orange needle cover automatically extends to cover the injection needle when the unit removed from the thigh. 9- You may feel anxious or having increased heartbeats, this is normal with Ep 10- Call 911, immediately bcz the effect of Epinephrine wears off after 10-15 min. and you may have the reaction again in the following 24h. 11- The used unit with extended orange needle cover will not fit back into the carrier, give the used unit to Emergency responders for inspection and disposal 12- Carry with you EpiPen wherever you go [ keep at home, work, friends, school, ,,] 13- Carry identification for any serious allergies 14- Dont keep it in the vehicle during extremely hot or cold weather 15- Store : room temp. away from direct sunlight 16- Occasionally inspect your unit, for any discoloration, solid particles or any leakage , replace with a new one if a

TWINJECT 1234567abcdefSupplied : 0.3ml of 0.3mg Ep for > 30 Kg & 0.15ml of 0.15mg Ep for 15-30 Kg. Proper use : Dont remove the green caps until you are ready to use Pull off green caps[ both #1 then #2 ] , you will see a red tip, Never put thumb, finger or hand over the red tip Put the red tip against the middle of the outer of your thigh, even through clothing, holding it in the injected site for 10 seconds [ count to 10 ], make sure all the medicine is delivered Remove the unit from your thigh Check the red tip, if the needle is exposed, you received the dose, if not repeat the 1st dose injection Call 911 Immediately prepare the 2nd dose : inject if symptoms persist after 10 min. while you are waiting for Emergency Unscrew and remove the Red tip, be careful of exposed needle Grab the blue plastic to pull the syringe out of the barrel [ dont touch the needle ] Slide the yellow collar off the plunger [ safety piece ] If symptoms dont improve within 10 min. since the 1st dose, use the 2nd dose Put the needle on your thigh, push the plunger down all the way, until no it cant go further, count to 10, remove the unit from your skin, get emergency help right away. After the 2nd dose, liquid will remain in the syringe that cant be used Put the syringe with the needle 1st into the carrying case, put the other half of the case and close it, give it to the healthcare worker for disposal.