The doctor has told you how important your inhaler is, your friends are telling you to use it regularly, you keep hearing about how imperative inhalers are for your condition, yet the little devices just don’t seem to be having the desired effect. Your asthma keeps flaring up, and the inhalers are unable to provide the relief you hoped for. Why is this? It could be that you aren’t getting the maximum benefit from your inhaler due to improper technique. Don’t be alarmed by this- up to one third of people are not using their inhalers in the correct way, according to a recent survey carried out by Asthma UK. (1) Speaking from personal experience, I distinctly remember a story I got told by a pharmacist during my time at university. She described how a patient with allergy-induced asthma thought that their inhaler was meant to be sprayed on their cat in order to relieve their own asthma attacks- no wonder it wasn’t having the desired effect! Admittedly this is a rare case, and a lot of problems people have are related to inefficient inhaler technique. A recent literature review found that as many as 25% of people with asthma have never received verbal inhaler technique instruction. (2) Throughout the course of this article, we will look at how to use different types of inhalers correctly, and where you can find more information.
1) Metered Dose Inhaler (MDI)
Metered Dose Inhalers are very common, and will often be the first type of inhaler prescribed for asthma. After removing the cap, the inhaler should be shaken thoroughly. This is done to help disperse the particles that cluster together when the inhaler is not being used. Take a long breath out, and place the inhaler in your mouth. Form a seal with your lips around the mouthpiece, and press on the canister as you start to breathe in. Understandably, you may have the urge to breathe in rapidly at this point, especially during an asthma attack, but it is important that you try and breathe in slowly and deeply. Once you have fully inhaled, hold your breath for around 10 seconds. This should allow the drug to penetrate deep into your lungs and provide maximum benefit. Repeat these steps for each puff ordered by the doctor, leaving about one minute between them. When finished, remove the device from your mouth and place the cap back on the mouthpiece. (3)
Seems simple, don’t you think? No, me neither. Using an MDI can be confusing and frustrating, and with this in mind you may find it easier to use a holding chamber. Your doctor can prescribe them, and the chamber can help enhance the effectiveness of the inhaler. If you are having any trouble using your MDI whatsoever, a chamber is definitely an option worth exploring, and can be discussed further with your pharmacist or GP.
2) Breath actuated MDIs
If you are having problems using a standard MDI, a breath actuated MDI could be the right product for you. When using this type of inhaler, there is no need to press on a canister- they are breath-sensitive, and therefore the only real necessity is that you breathe into the mouthpiece! The aerosol particles should then be automatically released. However, slow and deep breaths are required, and some patients find it difficult to breathe in slowly enough to obtain maximum benefit from the inhaler.
3) Dry Powder Inhalers (DPIs)
Often recognisable by their distinct disk shape, DPIs differ from MDIs in the type of particulates they release. Whereas MDIs contain an aerosol spray, DPIs are filled with medicine in a powder form that is triggered to release upon inhaling through the mouthpiece. (1) The technique for breathing in through a DPI also differs from that of an MDI. Rather than a slow breath, you should breathe through a DPI quickly and deeply for around 2-3 seconds. After this, remove the inhaler from your mouth. (3) On the downside, there are currently only a limited number of drugs available to be administered via the DPI. Furthermore, some patients find it difficult to achieve the deep breath needed for effective inhalation of the powder.
Although we have covered three of the most common types of inhalers within this article, there are many more available. If you are finding it difficult to use your inhaler or you feel your asthma/COPD is deteriorating, it is important that you visit your local pharmacist. Here at the the Hub Pharmacy, all of our pharmacists are willing to work together with you in order to achieve the best outcome. Simply pop into one of our stores and you can find out how to obtain the maximum benefit from your inhaler. Sometimes, it may be more beneficial for you to switch to a different type of inhaler, and we would be happy to discuss this with the doctor.
Article written by Thomas Payet
- Using your inhalers | Asthma UK [Internet]. Asthma UK. 2017 [cited 4 September 2017]. Available from: https://www.asthma.org.uk/advice/inhalers-medicines-treatments/using-inhalers/
- Effect of incorrect use of dry powder inhalers on management of patients with asthma and COPD – ScienceDirect [Internet]. Sciencedirect.com. 2017 [cited 4 September 2017]. Available from: http://www.sciencedirect.com/science/article/pii/S0954611107004477
- Metered Dose Inhaler | Cleveland Clinic [Internet]. Cleveland Clinic. 2017 [cited 4 September 2017]. Available from: https://my.clevelandclinic.org/health/articles/how-to-use-a-metered-dose-inhaler