What are the essential mistakes made while using inhalers?

Though inhalers are commonly used to treat people with asthma, chronic obstructive pulmonary disease (COPD), and other lung conditions, there are essential mistakes that patients often make when using them. The most critical mistakes are ones that lead to little or no delivery of the medication to the lungs because then if the patient is having an asthma attack, they will not receive effective asthma relief or asthma treatment. They may continue to experience wheezing and other symptoms of asthma.

There are two broad classifications of inhalers that are used for people with all types of asthma: metered dose inhalers (MDI) and dry powder inhalers (DPI) and mistakes can be made using either one, especially when proper instruction on how to use an inhaler is not given to the patient by his or her doctor. Some common mistakes when using MDIs are: not checking the mouthpiece for any foreign objects, not shaking the inhaler before use, not exhaling before inhalation, not holding the device in the right position, not being able to coordinate pressing down the inhaler with inhaling the medication, inhaling too rapidly, not inhaling deeply or at all, not holding one’s breath long enough after inhaling, not waiting at least 30 seconds in between inhaler doses, pressing down the canister more than once in a row, and not cleaning the device properly. Refer to Figure 1 for proper use of MDIs.

Proper Use of MDIs

Proper Use of MDIs

Using a spacer with MDIs can correct the mistake of not being able to coordinate pressing down the inhaler with inhaling the medication but there are common mistakes made when using a spacer as well. These include: not shaking the inhaler enough, not exhaling before inhaling the medication, waiting to inhale for too long after pressing down on the device, pressing down on the canister multiple times rather than just once, inhaling too rapidly, exhaling instead of inhaling after pushing down on the canister, and not holding one’s breath long enough after inhalation. Refer to Figure 2 for proper use of MDIs with spacers.

Proper Use of MDIs with spacer

Proper Use of MDIs with Spacers

Dry powder inhalers are generally used to provide better asthma control and long-term asthma management, and mistakes are also made with the use of these inhalers. Mistakes include: shaking the device which is not needed for DPIs, not exhaling slightly before inhaling, exhaling into the device which can disperse the powder medication, inhaling too slowly (a higher inspiratory flow rate is required when using DPIs), and failing to load the dose properly. See Figure 3 for proper use of DPIs (Diskus and Turbuhaler)

diskus inhaler


Turbuhaler inhalerTurbuhaler

It is important for asthmatics with both pediatric asthma and adult asthma to receive proper instruction on how to use their inhalers and to practice using their inhaler often, especially when they are first given an asthma diagnosis and inhalers are first being prescribed (there are placebo units available for patients to practice with). Doctors should educate patients and help with asthma management; this should include spending at least 10-30 minutes instructing patients about inhaler use and the instruction should include demonstration, practice and confirmation.

Turbuhaler inhaler


Source: www.aarc.org