Up to 90 percent of patients don’t know how to use their asthma inhaler, and they might be getting the wrong dose and have more side effects.
Most people don’t know how to use their asthma inhaler. The standard metered dose puffer requires that you shake it vigorously, breathe out completely, breathe in through your mouth, press down to release a spray, and continue breathing in slowly and deeply for about five seconds. You need to hold your breath for 10 seconds before you exhale. If you make a mistake, you very often end up swallowing much of the medication rather than inhaling it.
This can happen with a daily inhaler or a rescue inhaler you use when you feel asthmatic.
Although up to 90 percent of patients don’t use their inhalers correctly, this isn’t a small problem. You won’t be getting the right dose. You are more likely to develop resistance to the medication and need to switch. You also run more risk of side effects like feeling jittery, a yeast infection in your throat called thrush, or getting stomachaches from swallowed medication.
If your asthma isn’t controlled with your daily inhaler, and you also don’t use the rescue inhaler correctly, you run the risk of trips to the emergency room. Ten Americans die from asthma each day, a total of 3,651 in 2014.
How to use an inhaler
If you often taste bitterness after a puff or find a puff doesn’t help your breathing, pay attention. Caregivers should monitor inhaler technique in any recipient of care who suffers from asthma.
1. Did I shake the inhaler enough before each puff? The canister contains both the medication and a propellant. If you don’t shake it vigorously, at least four shakes, you won’t know how much you’re getting. Nearly 40 percent of users didn’t shake the inhaler, in a study of more than 1,600 adults in Italy.
2. Is the mouthpiece in the right position? The nozzle should point directly to the back of your throat. If it’s tilted up, the medication will go on the roof of your mouth; tilted down, it will hit your tongue.
3. Am I looking straight ahead? You can run into the same issues if you tilt your chin up or down. Stand up and make sure the bottom of your chin is parallel to the floor.
4. Am I releasing the medication at the right time? It’s best to start breathing in and press down to release the spray about a second later. If you find you have trouble with this step, you might consider getting a spacer attachment or using the Pro Air Respiclick, which deliver a powder into a chamber when you open up the top and hear a click. The powder is ready for you whenever you take a breath.
5. Am I using too much force or jerking? Some people press too hard and jerk a bit, and they’re no longer aligned.
6. Am I breathing too quickly? Make sure you breathe in for five seconds. Hold your breath for about 10 seconds before exhaling. In the Italian study, 53 percent of users either didn’t hold their breath or held it fewer than 3 seconds.
7. Am I rushing into a second puff? When you’re still struggling to breathe after one puff, you might want to immediately try again. But if your hands are shaky and you’re panicky, you might make the same mistake twice. Instead, pay more attention to your form the second time.
After you use an inhaler, rinse your mouth with water and spit it out. You don’t want to swallow medication that landed in your mouth. About once a week, remove the canister and cap and rinse the plastic mouthpiece and cap under warm running water. Let it air dry.
Do you need a spacer?
If you find it hard to pull this off — or are concerned about a child or elder who doesn’t seem to be helped enough by an inhaler — look into using a spacer. Smart inhalers with electronic chips are also coming down the pike. You might get reminders when you haven’t taken a daily dose or if triggers are in the air. Research is also underway to find pills you can take daily that are safer than the current corticosteroids.
September 08, 2017
Janet O’Dell, RN