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Proper inhaler technique: It is critical to effective asthma treatment

Published on Jun 19, 2011 with 0 comment

Is your asthma inhaler or your child’s inhaler seemingly not working?

If you or your child are not getting the desired results from an asthma inhaler, chances are that the inhaler is not being used correctly and efficiently. As a matter of fact, the proper inhaler use could be the most important factor in the success or failure in the treatment of asthma in children and adults.

The ability to use inhaled medications for the control and treatment of asthma is a major breakthrough. Metered dose inhalers, diskus inhalers, twist inhalers, and flexhalers are the most effective delivery systems for both preventative medications such as inhaled steroids, and for the fast acting bronchodilators such as albuterol, taken for immediate relief of asthma symptoms. But, for these medications to be helpful, one must know how to use an inhaler. If proper inhaler technique is not used, the medication will not be delivered to the lower airways - resulting in minimal or no improvement in symptoms. Unfortunately, every allergist and asthma specialist deals with the issue of improper inhaler technique every day.

If an asthma patient is not responding to a medication delivered by a metered dose inhaler, a diskus inhaler, or a flexhaler, the most likely explanation is that the patient is taking the medication less frequently than prescribed, or that they simply don’t know how to use an inhaler.  Proper inhaler technique is very simple, but it does require demonstration, coaching, and constant reinforcement.  The Online Allergist is a big proponent of inhaler “show and tell”.  It is incumbent upon every physician or nurse to demonstrate proper inhaler technique and a review of how to use an asthma inhaler should be an integral part of every visit. Pharmacists should also demonstrate proper inhaler technique when the medication is dispensed.

As a practicing allergist, I have seen adult patients who have been using inhalers for many years - and even decades - all the while using the inhaler incorrectly, and therefore receiving no benefit. Mistakes include spraying into the mouth but not inhaling, actuating multiple sprays at one time, and even holding the inhaler upside down. It is not a laughing matter, but had I taken videos over the years of adults and children using inhalers, I would have collected an endless chronicle of misuse and I could have sent them to a medical edition of World’s Funniest Videos. While being amused however, such inhaler techniques are inefficient and even dangerous.

The Online Allergist recommends that the following videos be watched to learn how to use an inhaler:

How to use an inhaler
How to use a Discus inhaler
How to use a Twisthaler

It is important to note that children less than 6 years of age generally cannot use an inhaler correctly, as it does require a certain amount of coordination. For young children, devices such as spacers, aero-chambers, and aero-chambers with mask are available and are widely prescribed.  However, these devices are not always efficient in delivering the appropriate dose of inhaled medication to the lower airways, and many allergists will recommend the use of a nebulizer, depending on the asthma medication that is prescribed.  Since little coordination is necessary, a nebulizer is often the delivery system of choice for infants and young children.  The PARI Vios Nebulizer and the PARI TRK S Nebulizer are very good nebulizers for both adults and children.

Proper inhaler technique is critical and potentially life-saving for both adults and children with asthma.  Make it a point to learn how to use an inhaler and make sure to practice frequently.


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