Each day, we take between 17,000 and 30,000 breaths. In and out. In and out. It’s an essential but mostly unconscious act. However, if you have asthma or other lung diseases, clear breathing can’t be taken for granted. More than 1.6 million emergency room visits each year are triggered by an asthma attack.
According to the Centers for Disease Control and Prevention (CDC), more than 17 million Americans live with asthma, and another 15 million have chronic obstructive pulmonary disease (COPD), both of which can leave patients literally out of breath and usually require the daily use of inhaled corticosteroids to reduce inflammation and keep airways open.
Unlike oral medications that are simple to take, inhaled medications require patients to consistently follow a specific sequence of steps to administer. Research shows that as many as 90 percent of those using metered-dose inhalers (MDIs) are making at least one mistake in this process.
“In my experience, easily 50 percent of patients are not using their inhaler correctly,” he says.
“I spend time training my patients on the proper technique associated with the inhaler being prescribed, and in addition, will recommend that the patient also talk to the pharmacist about the inhaler. I recommend that patients read the package insert that comes with the inhaler as there is often information on proper technique associated with that specific inhaler,” he says.
Common mistakes in using metered-dose inhalers include:
- Not shaking the inhaler before use
- Not holding or activating the inhaler properly
- Improper breathing technique, including breathing in too quickly, waiting too long to activate the inhaler, or not holding the breath long enough
- Not waiting long enough between doses
Research published in the Journal of Allergy and Immunology supports the use of a tube spacer with metered inhalers. These add-on devices reduce the chance that medication will hit the back of the throat and improve drug delivery to the lungs by allowing the drug to aerosolize in a chamber before inhalation.
The American Lung Association lists the following eight steps for optimum inhaler use:
- Make sure the inhaler and spacer are free of foreign objects. Shake the inhaler for 10 seconds to mix the medicine. Remove the cap from the mouthpiece.
- Place the inhaler mouthpiece onto the end of the spacer. Hold the inhaler between the index finger and thumb. Stand up, take a deep breath in and then breathe out as much as you can.
- Put the end of the spacer into your mouth, between your teeth and above your tongue. Close your lips around the spacer.
- Press down on the inhaler to release the spray, and begin to breathe in through your mouth. Breathe in deeply and slowly (for about 5 seconds) to pull the medicine deep into your lungs. If you breathe in too quickly, the spacer may make a whistling sound.
- Hold your breath for 5 to 10 seconds — as long as you comfortably can, with your mouth closed.
- Breathe out slowly through your mouth. If you breathe out too quickly, the medicine will not settle into your lungs.
- Wait one minute before taking a second puff, if so directed. Repeat steps 1 through 6 if taking a second puff.
- Rinse your mouth out with water, and spit.
If you or your child are just starting an inhaled medication — and even if you have been on these medications for years — Dr. Pauls recommends talking with your doctor.
“Discuss proper technique with the prescribing physician as well as the pharmacist. Also, read the material that comes with the inhaler. Children should also be assisted in using the inhaler and supervised while they take it,” he says.