Getting the Most from Your Inhaler

Amarita Bhoge and David Q. Pham, PharmD, BCPS
Published Online: Monday, May 1, 2006

If you are one of the millions who suffer from asthma, allergies, or other respiratory illnesses, you are likely to require an inhaler. An inhaler is a portable handheld device used to treat symptoms of shortness of breath, chest tightness, wheezing, and cough.

Generally, there are 2 ways that an inhaler may be used. The first way is as a "rescue" inhaler. A rescue inhaler should be used only when immediate symptom relief is needed—when you are having an asthma attack. The second way is as a "maintenance" inhaler. A maintenance inhaler must be used on a regular basis to prevent attacks. Maintenance inhalers will not relieve an attack that has already started.

Overall, inhalers allow patients to lead active lifestyles without being afraid of an attack. They deliver the necessary amount of medication directly to the lungs where it is needed.

Many people, especially children and older individuals, have difficulty using an inhaler in the proper way. In most instances, patients are not aware that they are using the inhaler incorrectly until after they are admitted to an emergency room suffering from an attack.

Specific techniques are necessary for the proper use of an inhaler. Always check with your doctor or pharmacist to ensure that you are using your inhaler appropriately. Getting the most from your inhaler will greatly improve your ability to manage your asthma.

Types of Inhalers

There are several types of inhalers. The most common are metered-dose inhalers (MDIs) and dry powder inhalers (DPIs). See the box for tips on the differences between MDIs and DPIs.

Metered-dose Inhalers

MDIs, such as AeroBid and Proventil, use chemical substances to release medication from the inhaler device. As you press on the canister, a small burst of medicine is sprayed. This amount is referred to as a "puff" of the medication.

MDIs require you to take 2 actions at the same time: push down on the canister and inhale the medication. Timing is important, because depressing the canister too early or too late or inhaling the medicine too early or too late may result in poor drug absorption. Spacers are recommended if you have a problem coordinating depressing the canister and breathing.

There are 3 ways of using your MDI: with your mouth open, with your mouth closed, and with a spacer. Either the open-mouth or the spacer method is a better choice. In the closed-mouth method, the medication becomes stuck at the back of the throat, rather than being mostly absorbed in the lung.

With all MDIs, it is important to press the canister and breathe in slowly at the same time so that the medicine gets into your lungs. This step may be difficult at first. If you are using the closed-mouth method and you see a fine mist coming from your mouth or nose, the inhaler is not being used correctly.

Once the medication is inhaled, hold your breath as long as you can, for up to 10 seconds. Doing so gives the medicine time to settle into your lungs. Take the mouthpiece away from your mouth, and breathe out slowly.

If your doctor has told you to inhale more than 1 puff of medicine at each dose, wait 1 minute, gently shake the inhaler again, and take the next puff. Follow exactly the same steps you used for the first puff.

Dry Powder Inhalers

DPIs, such as the Advair Diskus, release the medication by rapid inhalation, rather than using chemical substances to release it. With a DPI, you must inhale more strongly to release the medication than with an MDI. DPIs require that you place your lips on the mouthpiece and inhale as rapidly and forcefully as possible.

The dry powder medicine can be enclosed in a capsule (a Spinhaler), in a circular disk (a Diskhaler), or in a special apparatus (a Turbuhaler). Spacers must not be used with DPIs. Timing coordination is not necessary.

Using a Spacer

A spacer is a device used to aid medication delivery to the lungs. It is usually a short hollow tube that can be attached to the mouthpiece of an inhaler, which allows medication to be held in a chamber. Releasing the medication into a chamber gives patients time to inhale more slowly and allows for drug molecules to become smaller before entering the lung.

This method is ideal for patients who have difficulty timing depressing the canister and inhaling. It decreases the amount of medication that is deposited on the back of the throat and increases the amount that reaches the lungs. Getting the right amount is especially important if you are using a steroid inhaler, such as Beclovent, Flovent, or Pulmicort.

Testing and Priming Inhalers

When you use an inhaler for the first time, or if you have not used one in a while, the inhaler may not deliver the correct amount of medicine with the first puff. Therefore, before using the inhaler, you may have to test or prime it.

To do so, insert the medicine canister firmly into the clean mouthpiece according to the manufacturer's directions. Check to make sure that the canister is placed properly into the mouthpiece. Take the cap off the mouthpiece, and shake the inhaler 3 or 4 times. This shaking will allow for equal mixing of the medication's ingredients. Hold the inhaler well away from you, at arm's length, and press the top of the canister, spraying the medicine into the air 2 times. Look to see if a fine mist of medication has been released. The inhaler will now be ready to provide the right amount of medicine when you use it.

Conclusion

Inhalers are valuable devices when used correctly. They may save your life. It is important to consult with your doctor or pharmacist to ensure that you are using your inhaler correctly. Once you are using your inhaler correctly, you should be able to lead an active lifestyle.

Ms. Bhoge is a PharmD candidate at the Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Long Island University. Dr. Pham is an assistant professor of pharmacy practice at the same institution.




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