As a Respiratory Therapist, it is crucially important to know and understand how to properly use an inhaler. That is because we are responsible for instructing patients with the proper technique, which will allow them to consume their medication to the best of their ability. 

According to a report issued by the Forum of International Respiratory Societies in 2013, it is estimated that more than 1 billion people suffer from chronic respiratory conditions and each year, 4 million people die prematurely from chronic respiratory disease. The five most common respiratory conditions mentioned in the report are as follows:

1. Chronic Obstructive Pulmonary Disease (COPD)
2. Asthma
3. Acute respiratory infections
4. Tuberculosis; and
5. Lung cancer

While there are several alternatives for treating these illnesses, Metered Dose Inhalers (MDI), as well as Dry Powder Inhalers (DPI), are among the most common medicines used for these diseases. For this article, we will focus on MDIs.

What is a Metered Dose Inhaler?


A metered dose inhaler is an L-shaped hand-held plastic container, which encloses a detachable tin canister containing aerosolized medicine. On the short end of the plastic container is often a mouthpiece, which provides an opening that allows for the patient to inhale it before it is delivered to the lungs to provide relief.

How does an MDI work?


The medication is released by pressing the tin canister, which releases the suppressed medication, thereby allowing it to travel through the mouthpiece, where it is inhaled through the mouth to the lungs. Doses are often numbered so it is important to always keep track of how many doses are remaining.

How do I use a metered dose inhaler?


1. Remove the lid from the inhaler
2. Shake the inhaler for 3 to 4 seconds
3. Place your index finger on top of the tin canister then place your thumb on the bottom of the mouth piece (i.e. short end of the L-shaped plastic container)
4. Breathe out away from the inhaler
5. Bring the inhaler to your mouth then place it in your mouth and close your mouth around it
6. Hold it upright then press down the inhaler while you simultaneously breathe in slowly and inhaling the medication
7. Hold your breath for a few seconds then breath out
8. Remove the inhaler from your mouth
9. Place the lid on the inhaler again then
10. Wash or rinse out your mouth with water or mouthwash

Advantages of using an inhaler


1. The inhaler as hand-held device is portable, easy to carry and use.
2. Owing to the plastic container and the tin canister, the inhaler is not affected by humidity.
3. As it is one of the most common medications, it is affordable and low-costing
4. Metered doses allow one to know how many does are remaining.
5. As soon as the medication is released from the mouth to the lungs, the impact is felt immediately.
6. Medicine is widely available at local pharmacies, clinics, and hospitals, making it easy to access.

Disadvantages of using an inhaler


1. It is difficult to establish whether or not an inhaler has been used up if it does not have a dose meter or counter.
2. For many, being able to coordinate breathing and pressing the inhaler simultaneously is a problem.
3. Drug doses cannot be lowered or increased, thereby making inhalers inflexible
4. Some patients have negative (allergic) reactions to the aerosol medicines used inhalers.
5. As the tin canister holds suppressed medicine, it cannot be exposed to high temperatures as it may explode.

Common mistakes and errors in using metered dose inhalers


The European Journal lists the following as some of the most common mistakes and errors associated with using these devices:

1. Improper inhalation- this affects the inhaler’s ability to provide medication to the lungs in the way that it is supposed to.
2. Failure to hold inhaler upright- this causes the medication to hit the back of the throat, which can cause mild irritation of the throat.
3. Breathing out before inhaling the medication- which causes the medication not to be ingested properly and some are blown out and lost during premature exhalation.
4. Incorrect dose loading- this primary relates to the patient not pressing the tin canister properly when preparing the medication for inhalation. It is important to put the index and thumb fingers at the right places for the inhaler doses to come out correctly and with the least amount of effort.
5. Not shaking the inhaler before use- if the inhaler is not shaken, the aerosolized medication disintegrates and when you pump the inhaler without shaking it, too much or too little of the mixed contents may be released. However, by shaking the container, the contexts will be mixed and will be released in the correct doses.
6. Using nose instead of mouth to inhale- The aerosolized medication in the inhaler cannot travel to the lungs when it is inhaled to the nose rather than the mouth.
7. Fast and forceful breathing- When inhaling the medication, breathes must be slow, deliberate and deep in order to ensure that the medical contents are properly ingested.
8. Not cleaning the inhaler- as the inhaler is used through a mouthpiece, it is important to always keep lid closed and ensure that mouthpiece is always clean to prevent germs from penetrating the container, which could lead to illness. Ensuring that the medicine cap is always on is a good way to ensure that the inhaler remains safe and clean.

Additional accessories


Owing to various customer preferences, inhalers now come with a range of functional additions such as a spacer, which allows for the easy inhalation of the medication through tubes which contain the medicine and allow the patient to breathe slowly while taking it in. Other accessories include neck or key chains, which can be attached to the inhalers and allow for easy carrying for the inhaler during exercise or on a set of keys. Latest offerings also include cases and pouches, which help protect the inhalers much in the same way that cell phone cases protect cell phones. These cases and pouches also furthermore help keep the devices clean.

You can even purchase a spacer of your own on Amazon.com.

Final thoughts


Now you know how to properly use an inhaler and also some of the most common mistakes that you should avoid. Whether you are a patient using an MDI yourself, or a Respiratory Therapist learning to teach proper technique, you now have all the information you need about inhalers and how to use them the correct way.