Improper Inhaler Technique: Affect Asthma Control

Healthcare professionals can support patients in optimizing their technique by examining the effects of the sub-optimal inhaler.

Inhalers used to treat asthma and chronic obstructive pulmonary disease (COPD). Thus, inhalation techniques play a major role in improving drug adherence.

About 92% people with asthma use their device incorrectly. Improper inhaler have been reported in children and adults, including experienced inhaler users

Moreover, improper inhaler technique can prevent drugs from reaching to lungs. It can be effective if the patient used in correct ways. Good inhalation techniques are very important to maximize the benefits of these drugs.

Hence, the correct technique depends on what type of inhaler. Some inhaler steps differ according to the type of inhaler.

Besides, healthcare professionals must be proficient in how to use correctly of each inhaler device and need to be aware of common mistakes so they can confidently demonstrate in front of patients.

However, you can purchase the inhaler with doctor’s prescription at any pharmacy, and healthcare professional can buy from any pharmaceutical company such as Mayflax.

Types of Asthma Devices

Common inhaler are used to deliver asthma and chronic obstructive pulmonary disease (COPD) medications which are metered dose inhalers (MDIs), dry powder inhalers (DPIs), and soft mist inhalers (SMIs).

Meanwhile, each type of inhaler has advantages and disadvantages. Below, the various types and technique of inhaler medical device :-

1. Pressurised metered dose inhaler (PMDI)

Description

Drug is stored under pressure in the metal canister
A fine mist of medication is released upon pressing the canister that can be inhaled into the lungs
Works well with a valved holding chamber (VHC) or spacer.

How to use?

First, need to remove cap.
Second, hold inhaler upright and shake well.
Third, breathe out gently and away from inhaler.
Fourth, put mouthpiece between teeth without bite and close lips to form a good seal.
Start to breathe in slowly and deeply. At the same time, press the inhaler device.
Hence, hold breath for 5 to 10 seconds.
While holding breath, remove inhaler from mouth.
Breathe out gently and away from the inhaler.
Repeat dose if needed and replace cap.
Lastly, clean device if necessary after use.

Available Brand in Malaysia

Ventolin® MDI (Salbutamol)
Flixotide MDI (Fluticasone)
Flutiform® MDI (Fluticasone/Formoterol)
Foster® MDI (Beclometasone/Formoterol)
Alvesco® MDI (Ciclesonide)

2. Tuberhaler

Description

Dry powder inhaler (DPI)
No coordination required
Device dispenses a small amount of very fine powder directly into the lungs
Comes with a dose indicator

How to use?

First, need to unscrew and remove cover.
Second, check dose counter.
Third, keep inhaler upright while twisting grip at the base.
Twist around and then back until click is heard.
Then, breathe out gently, and away from the inhaler.
Fourth, put mouthpiece between teeth without bite and close lips to form good seal
Do not cover the air vents.
Breathe in strongly and deeply.
Fifth, hold breath about 5 to 10 seconds.
Hence, remove the device before breathing out fully.
If more than one dose is needed, repeat all steps starting from step 3.
Lastly, replace cover and clean the device if necessary.

Available Brand in Malaysia

Symbicort® Turbuhaler (Budesonide/Formoterol)
Pulmicort® Turbuhaler (Budesonide)
Bricanyl® Turbuhaler (Terbutaline)

3. Respimat soft mist inhaler

Description

Dispenses fine and easy to inhale droplets directly deep into the lungs.
Requires very less effort during inhalation
Comes with a dose indicator

How to use?

Hold inhaler upright with the cap closed.
Then, turn base in direction of arrows on label until it clicks. Half a turn.
Open the cap until it snaps fully open.
Breathe out gently, and away from inhaler.
Moreover, put mouthpiece in mouth and close lips to form a good seal.
After that, start to breathe in slowly and deeply through mouth;
And at the same time, press down on the dose button.
Continue to breathe in slowly and deeply.
Hold breath for 5 to 10 seconds.
While holding breath, remove inhaler from mouth.
Breathe out gently, away from mouthpiece.
Close cover to click shut.
If you need two doses, repeat from step 1 to get the full dose.

Available Brand in Malaysia

Spriva Respimat® (Tiotropium)

4. Accuhaler

Description

Dry powder inhaler (DPI)
No coordination required
Device dispenses a small amount of very fine powder directly into the lungs
Comes with a dose indicator

How to use?

Check dose counter.
Open cover using thumb grip.
Load dose.
Keep device horizontal or upright while sliding lever until it clicks and do not shake.
Then, breathe out gently but not into device.
Put mouthpiece in mouth, without biting and close lips to form a good seal.
Breathe in quickly and deeply.
After that, hold breath for a count of ten.
While holding breath, remove inhaler from mouth.
Slowly breathe out.
If more than one dose is needed, repeat all steps starting from step 3.
Close cover to click shut.
Clean device if necessary after use.

Available Brand in Malaysia

Seretide® Accuhaler (Salmeterol/Fluticasone)

5. Ellipta

Description

Medication is stored under pressure in the metal canister
A fine mist of medication is released upon pressing the canister that can be inhaled into the lungs
Works well with a valved holding chamber (VHC) or spacer.

How to use?

First, check dose counter and do not shake.
Second, slide cover down until click is heard.
Third, breathe out away from inhaler.
Fourth, put mouthpiece in mouth and close lips to form a good seal;
And do not block air vent with fingers.
Then, breathe in steadily and deeply.
Fifth, hold breath about 5 to 10 seconds.
While holding breath, remove inhaler from mouth.
After that, breathe out gently, and away from inhaler.
Slide the cover upwards as far as it will go, to cover the mouthpiece.
Lastly, rinse your mouth with water and spit it out for a steroid-containing inhaler.

Available Brand in Malaysia

Ventolin® MDI (Salbutamol)
Flixotide MDI (Fluticasone)
Flutiform® MDI (Fluticasone/Formoterol)
Foster® MDI (Beclometasone/Formoterol)
Alvesco® MDI (Ciclesonide)

Common Errors with Inhaler Technique

Not breathing with the proper way.
Breathing in too early and too late when pressing the inhaler canister.
Forget to shake the inhaler before use.
Not waiting for the next puff. Some inhalers, need to wait at least 30 to 60 seconds before taking the next puff.
Hence, not breathing out before using the inhaler and does not have a tight lip seal.
Not lifting your chin slightly before breathing in.
Furthermore, not holding your breath after taking the inhaler;
As well as, not using a spacer when needed.

Guidance of How To Use Your Asthma Devices?

This video shown how to use different types of inhalers.

References:

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ABOUT THE AUTHOR

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Raihan Ridzuan

Raihan Ridzuan, Bachelor of Science (Hons) Pharmacology, is Customer Relationship Executive of Mayflax, one of the nation’s leading healthcare and marketing company.

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