Counselling

General Technique

Establish

• WIPE
• Why they’ve come to see you - open question
• ICE

BUCES structure for infomation sharing

• Brief history - events, PMH, FH, DH, SH
• Understanding
• Concerns
• Explanation
• Summarise

NWCPM for explaining disease

• Normal anatomy/physiology

• What the disease is

• Cause

• Problems/complications

• Management

Closing the consultation

• Ask them to repeat back everything that you’ve told them and answer any further questions
• Arrange a follow up appointment
• Thank them for their time

Inhaler technique

• Check what time of inhaler it is and explain if misunderstanding
• Acute: 10 doses max 2 puffs each dose then 999

Before using the inhaler

• If the inhaler hasn’t been used in 5+ days test by shaking and pressing into air
• Expiry date

Technique

1. Hold the inhaler upright
2. Remove the cap and inspect
3. Shake well
4. Sit or stand straight up and slightly tilt chin up
5. Breathe out gently and slowly away from the inhaler until your lungs feel empty
6. Out lips around the mouthpiece to create a tight seal
7. Start to breathe in slowly whilst pressing the canister
8. Continue to breath in until lungs are full
9. Remove inhaler and close mouth
10. Hold breath for 10 seconds
11. Breathe out gently
12. If used steroid inhalcer rinse mouth with water to reduce change of side effect

Assess their technique

• Ask the patient to use their inhaler to demonstrate their technique
• Provide feedback and refine technique

Spacer devices

1. Prepare the inhalcer as previously explained
2. Attach the spacer
3. Use the inhaler as before but breath deeply both in and out several times
4. Administer a second dose if required

Spacer should be washed once a month to air dry and replace once a year

Peak Flow

1. Ensure the peak flow is set to zero
2. Position yourself standing
3. Take the deepest breath you are capable of
4. Hold the peak flow meter parallel to the floor and position your mouth around the mouthpiece of the peak flow meter creating a tight seal with your lips
5. Exhale as forcefully and quickly as you are able to - like a cough
6. Repeat twice more
7. The highest reading should be used as the final result