The New Age of Inhalation

DECEMBER 27, 2015
Not too long ago a gentleman walked into our little outpatient pharmacy, directly up to the counseling area, and stood there looking toward the back of the counter. 
 
It didn’t take much for me to notice him; he was definitely on a mission. After a few moments of finishing up the task I was working on, I gave him a nod of recognition and asked how I could help him.
 
In a straightforward and meaningful manner, he took his new Respimat inhaler and set it on the counter. 
 
"This is broken," he said. 
 
"Well, let's have a look at it," I responded.
 
The gentleman informed me that he had been discharged from one of the local hospitals the day before.  
 
Among other medications, his doctor had prescribed this Combivent Respimat inhaler for him to use. He explained that when he picked up the inhaler at his regular pharmacy, he had declined counseling.  
 
The gentleman was visiting a physician in our clinic, so he thought he might as well stop into our pharmacy, and see if we could help him understand what might be wrong with his inhaler.  
 
I do give him great credit for recognizing that his product did not work, and it needed to be fixed so that he would be in a better position to use the device.
 
As the gentleman was telling me his story, I slowly picked up the inhaler and looked at it.  
 
I turned it around a couple times, but it appeared to be in perfect working order.  
 
With the cap closed, I held one-half of the inhaler while I twisted the other half 180 degrees, as the packaging dictated. Next, I used my thumb to flip up the inhalation cap.  
 
Now, for the moment of truth. I held the container in the air, pointing away from both the gentleman and myself, and pressed the activation button. 
 
Much to his surprise a single dose of ipratropium/albuterol inhalation aerosol poured right out of the metered dose inhaler in a beautiful fine mist.  
 
I looked at him and said, "Sir, I believe your inhaler works just fine. The issue is you were never instructed on how to use this particular inhaler."
 
On behalf of the pharmacy profession, I apologized for him being allowed to leave a pharmacy without proper instruction on how to use his inhaler. We then proceeded to walk through a complete counseling session regarding his new inhalation medication and device.
 
Over the past few years, a multitude of new inhalation devices that are not your standard point-and-press inhalers have come into the market. 
 
They all involve some patented form of twisting, clicking, or loading, and they come with trademarked names such as Flexhaler, Respimat, Diskus, Handihaler, RespiClick, Ellipta, and Twisthaler, just to name a few. 
 
Whenever a patient is prescribed one of these new inhaler devices for the first time, it is inappropriate to allow the patient to decline the counseling session.
 
Take the time to instruct him or her on how to use the new device with the manufacturers’ training device. Next, have the patient demonstrate their knowledge of the device back to you before allowing him or her to leave.


Steve Leuck, PharmD
Steve Leuck, PharmD
Steve Leuck, PharmD, has been practicing both hospital and community pharmacy for over 30 years. He founded AudibleRx, in 2011, which provides Consumer Medication Information which is both Useful and Accessible. Content designed to meet health literacy guidelines. Format designed to "read along" with the audio presentation in a simple to use web application. More information at AudibleRx.org.
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