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 include:
- Chronic Obstructive Pulmonary Disease (COPD)
- Acute respiratory infections
- 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 to Use a Metered Dose Inhaler?
Here is a step-by-step process for using an inhaler with proper technique:
- Remove the lid from the inhaler
- Shake the inhaler for 3 to 4 seconds
- Place your index finger on top of the tin canister then place your thumb on the bottom of the mouthpiece (i.e. short end of the L-shaped plastic container)
- Breathe out away from the inhaler
- Bring the inhaler to your mouth then place it in your mouth and close your mouth around it
- Hold it upright then press down the inhaler while you simultaneously breathe in slowly and inhaling the medication
- Hold your breath for a few seconds then breath out
- Remove the inhaler from your mouth
- Place the lid on the inhaler again then
- Wash or rinse out your mouth with water or mouthwash
A Respiratory Therapist can follow this process when instructing their patients on how to use an inhaler.
What if the Patient Has Trouble with Hand-Breath Coordination?
Oftentimes, patients will not be able to coordinate their breath to align properly for when they initiate the dose. In this case, it’s important to use a space or holding changer. This way, the patient can initiate the dose within a chamber that the aerosol will be held temporarily so the patient is better able to inhale the full dose.
You can even purchase your own spacer on Amazon, however, you should speak with your doctor or medical professional about what medical equipment is right for you.
This MDI spacer improves coordination with your breath so that you can receive the intended dose.
What are the Advantages of Using an Inhaler?
The following are six advantages of using an inhaler:
- The inhaler as a hand-held device is portable, easy to carry, and easy to use.
- Owing to the plastic container and the tin canister, the inhaler is not affected by humidity.
- As it is one of the most common medications, it is affordable and low-costing
- Metered doses allow one to know how many does are remaining.
- As soon as the medication is released from the mouth to the lungs, the impact is felt immediately.
- Medicine is widely available at local pharmacies, clinics, and hospitals, making it easy to access.
As a Respiratory Therapist, it’s important to know when to recommend an inhaler as opposed to a small volume nebulizer treatment.
What are the Disadvantages of Using an Inhaler?
The following are the five primary disadvantages of using an inhaler:
- It is difficult to establish whether or not an inhaler has been used up if it does not have a dose-meter or counter.
- For many, being able to coordinate breathing and pressing the inhaler simultaneously is a problem.
- Drug doses cannot be lowered or increased, thereby making inhalers inflexible
- Some patients have negative (allergic) reactions to the aerosol medicines used inhalers.
- As the tin canister holds suppressed medicine, it cannot be exposed to high temperatures as it may explode.
Although these disadvantages exist, inhalers offer a ton of benefits when used correctly. Just be sure to avoid the common mistakes that are listed below.
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What are the Most Common Mistakes and Errors That Occur When Using a Metered Dose Inhalers?
The European Journal lists the following as some of the most common mistakes and errors associated with using these devices:
- Improper inhalation – this affects its ability to provide medication to the lungs in the way that it is supposed to.
- Failure to hold the inhaler upright – this causes the medication to hit the back of the throat, which can cause mild irritation of the throat.
- 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.
- Incorrect dose loading – this primarily 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.
- 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.
- 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.
- 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.
- Not cleaning the inhaler – as the inhaler is used through a mouthpiece, it is important to always keep the lid closed and ensure that the 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.
Of course, other mistakes are possible as well. These are just some of the most common examples.
Additional Accessories for an Inhaler:
It depends on the customer preferences, but inhalers sometimes come other accessories. These include neck or key chains, which can be attached to the inhalers and allow for easy carrying 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 can help keep the devices clean.
Helps to protect your inhaler and keep it clean while on the go.
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
We have a guide on Flutter Valves as well that I think you will enjoy. Thank you so much for reading and as always, breathe easy my friend.
- Faarc, Kacmarek Robert PhD Rrt, et al. Egan’s Fundamentals of Respiratory Care. 12th ed., Mosby, 2020. [Link]
- Faarc, Gardenhire Douglas EdD Rrt-Nps. Rau’s Respiratory Care Pharmacology. 10th ed., Mosby, 2019. [Link]
- “Forum of International Respiratory Societies (FIRS).” American Thoracic Society, www.thoracic.org/about/global-public-health/firs.
- “How to Use an Inhaler – No Spacer.” MedLine Plus, 13 Jan. 2020, medlineplus.gov/ency/patientinstructions/000041.htm.
- “CDC – Asthma – Using an Asthma Inhaler Videos.” Center for Disease Control and Prevention, 7 Mar. 2018, www.cdc.gov/asthma/inhaler_video/default.htm.
- “Ask the Expert | What’s the Proper Way to Use an Inhaler?” Kootenai Health, www.kh.org/ask-the-expert-whats-the-proper-way-to-use-an-inhaler. Accessed 30 July 2020.