By Dr. Paul Ehrlich
According to an editorial in Drug and Therapeutics Bulletin (DTB), healthcare professionals are as bad as patients when it comes to knowing how to use inhalers prescribed for asthma and other respiratory conditions correctly. The British study says, “Four of the top 10 most expensive NHS drugs last year were reliever or preventer inhalers for asthma and other respiratory conditions…Numerous studies over the past 30 years have shown that many patients cannot use inhalers correctly and over 50% of [them] struggle to use a metered dose properly…Of perhaps more concern is the fact that many health professionals also do not know how to use inhalers correctly and are therefore not in a position to coach patients effectively.”
While this was British data, I have no reason to think the situation is any better in the US. At Columbia University College of Physicians and Surgeons a few years ago, a class of residents was given a demonstration in how to use an inhaler, and a month later, no one could do it properly. Consider all the reasons why most asthma is uncontrolled: wrong medications, cost of medication, failure to avoid triggers, pollution, and the tendency to confuse absence of symptoms with an absence of inflammation.
Add to this the low yield. Even when done properly, only a fraction of the particles in a metered dose reach the lungs, with the rest sticking to the inside of the mouth and throat.
These are the tips I give my patients:
1) With an aerosol, always use a spacer. The medication jets out of the inhaler at 60 miles an hour. It’s hard to coordinate that with a deep breath. The spacer will capture the gas suspension for about five seconds, which will give you more time to inhale.
2) If you do not have a spacer, don’t close your lips tightly around the mouthpiece. Relax and let a bit of air in. The tension produced when you close your lips will close your throat a bit and reduce the flow of medication to your airways, whereas the air coming in around the edges will help create a more comfortable stream to your lungs.
3) Take two puffs, as directed for both diskus and aerosols, 30 seconds apart. The first one will help loosen up your lungs for the second. Don’t take a second dose, even if you feel you didn’t get enough the first time.