Gout vs Pseudogout :Risk Factors,Causes, and Symptoms


Gout is a common form of arthritis. It is also a painful condition that usually involving the joints. It is caused by high levels of uric acid in the blood. Uric acid is formed when the body breaks down purines. The purines can be found in the body and certain foods. When symptoms get worse, it is known as flares. When there are no symptoms, it is known as remissions.

Risk Factors

There are many risk factors for gout.Gout generally develops in men between age 30 to 45 and women age 55 to 70.

Increased Risk for Developing Gout:

  1. Obesity.
  2. High Blood Pressure.
  3. Injury or recent surgery.
  4. Fasting or overeating.
  5. Consuming an excessive amount of alcohol regularly.
  6. Diet high in meat, shellfish, and beverages sweetened with high-fructose corn syrup.
  7. Taking medications that can increase blood levels of uric acid.


Gout occurs when there is an excess of uric acid in the body. The body makes uric acid when it breaks down purines. Purines are found in the body and the foods we eat. Usually, uric acid crystals can build up in joints, fluids, and tissues within the body when there is an excess of uric acid in the body. Hyperuricemia does not always cause gout. In addition, hyperuricemia without gout symptoms does not need to be treated. The sharp, needle-like crystals cause gout. 


  1. Intense joint pain: can occur at any joint but usually affects the big toe.
  2. Inflammation and redness: joint is usually swollen, warm, and red.
  3. Limited movement: not able to move joint normally.
  4. Lingering discomfort: last from few days to a few weeks.

Symptoms develop quite rapidly. It can last for three to ten days. Usually, the symptoms and signs affect a single joint. Gout attacks are very painful. It can happen quite suddenly, often overnight. The pain is typically severe. So, it shows the severity of inflammation in the joint. The medical term for excessive fluid in a joint is a “joint effusion”.


  1. Nonsteroidal anti-inflammatory drugs (NSAIDs) – reduce swelling and pain. It is used as first-line treatment.
  2. Colchicine – people who cannot tolerate NSAIDs usually take  colchicine.
  3. Steroids (prednisone) – used in people who cannot take NSAIDs or colchicine. Prednisone is linked with an increased risk of a recurrent gout attack.


Pseudogout also is a form of arthritis that causes sudden joint pain and swelling. It is caused by calcium pyrophosphate dihydrate crystals (CPPD). 

The sudden attacks of joint pain, swelling, and warmth can occur when you have pseudogout. It can last for days to weeks. It can affect the ankles, feet, shoulders, elbows, wrists, or hands but it mostly affects the knee.

Risk Factors

Besides older age, several other factors also increase the risk for developing pseudogout :

  • Joint trauma due to injury or surgery.
  • Genetics: some people tend to develop pseudogout and more likely to have symptoms at an earlier age.
  • Excess iron: people with a genetic disorder that causes the body to store excess iron.
  • Other disorders: some disorders that affect metabolism or endocrine glands are likely to develop pseudogout.


Pseudogout occurs when calcium pyrophosphate crystals form in the synovial fluid in the joints. Crystals can also deposit in the cartilage and can cause damage. The formation of crystal in the joint fluid results in swollen joints and acute pain. Older people have higher possibilities of getting pseudogout compared to younger people. In addition, the genetic condition can cause pseudogout because it always occurs in families.

In addition, other factors may include :

  • Low activity of the thyroid gland.
  • Parathyroid glands create too much parathyroid hormone.
  • Excess iron in the blood.
  • High calcium levels in the blood.
  • Lack of magnesium.


Pseudogout most often affects the knees. In addition, it also affects the ankles, wrists, and elbows.

General symptoms may include:

  1. Bouts of joint pain
  2. Swelling of the affected joint
  3. Fluid build up around the joint
  4. Chronic inflammation


Until now, no treatment can completely remove or prevent the formation of calcium pyrophosphate dehydrate crystals. Therefore, treatment is generally focused on reducing pain and swelling.

  • Joint injection: insert a needle into the affected joint and take off the fluid. So, the crystals, pressure, and pain will be relieved. Injection of a steroid into the joint can decrease the amount of inflammation present.
  • Oral medications such as NSAIDs, prednisone, and colchicine can decrease inflammation and pain.
  • Joint immobilization: avoid lifting heavy objects if it involve the legs.


Nur Ayuni Mohd Ruduan

Nur Ayuni Mohd Ruduan

Nur Ayuni Mohd Ruduan, Bachelor of Science (Hons) Pharmacology, is staff officer of Mayflax, one of the nation’s leading healthcare and marketing company.

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High Cholesterol : Types, Tests, Risk, Prevention, Treatments.

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High Cholesterol :Types, Tests, Risk, Prevention, Treatments

Picture of level cholesterol

What is cholesterol?

Cholesterol actually is good for health. Our body needs cholesterol to perform and supports the normal function of cell membranes, hormone levels, and others. Moreover, if cholesterol level in your blood increased can lead to hyperlipidemia, hypercholesterolemia, or high blood cholesterol. 

Besides, if the human body having more cholesterol in the blood, it will build up inside the walls of blood vessels. This buildup is called plaque, or atherosclerosisPlaque will blocks the blood flow and cause a:

Cholesterol can be either good or bad. Furthermore, cholesterol is an oil-based substance. It does not mix with the blood, which is water-based and travels around the body in lipoproteins.

Moreover, cholesterol can be found in egg yolks, meat, and cheese and others.

Types of cholesterol

There are three types of cholesterol:

  • Low-density lipoproteins (LDL): Also known as “bad” cholesterol. High levels of LDL cholesterol may risk of heart disease and stroke.
  • High-density lipoproteins (HDL): Also known as “good” cholesterol, it carries cholesterol back to the liver. Then, the liver flushes it from the body. High levels of HDL cholesterol can lower the risk of heart disease and stroke.
  • Very-low-density lipoproteins (VLDL) are particles in the blood that carry triglycerides. VLDL stands for very low-density lipoprotein.  VLDL also called as “bad” cholesterol because it buildup of plaque in arteries. However, VLDL and LDL are different which is VLDL carries triglycerides and LDL carries cholesterol.

Levels and ranges

Therefore, cholesterol is measured in milligrams per deciliter (mg/dL). The target range for cholesterol levels are (Centers for Disease Control and Prevention [CDC], 2020):

Lipid Profile Normal Range
Total cholesterol< 200 mg/dL
LDL (“bad”) cholesterol < 100 mg/dL
HDL (“good”) cholesterol≥ 60 mg/dL
Triglycerides< 150 mg/dL

Test to measures cholesterol

Cholesterol levels must measured at least once every five years, possibly as early as age 20 years.

Furthermore, high cholesterol usually has no signs or symptoms. You may also not know you are having a bad cholesterol levels in your body until sudden heart attack or stroke happen. So, it so important to check your cholesterol levels at least every 5 years.

The cholesterol screening, requires a blood sample. Therefore, before do cholesterol test, need to fasting for about 8 to 12 hours. Usually people will fast at night and do the test on the next morning.

The cholesterol test checks the levels of:

  • Low-density lipoprotein (LDL). 
  • High-density lipoprotein (HDL). 
  • Triglycerides is a type of fat in your blood that your body uses for energy. The combination of high levels of triglycerides with low HDL cholesterol or high LDL cholesterol levels can increase your risk for heart attack and stroke.
  • Total cholesterol is the total amount of cholesterol in the blood based on your HDL, LDL, and triglycerides numbers.

What risk factors affect cholesterol levels?

Risk factors that may raise your high cholesterol:

Age:  When get older, the cholesterol levels may rise. However, young people, such as children and teenagers also tend to have high cholesterol.

Heredity: High blood cholesterol can run in families.

Weight: Being overweight or obese also increases your cholesterol level.

Race: Some races may have an increased risk of high cholesterol. For instance, African Americans have higher HDL and LDL cholesterol levels than whites.

Diet: Saturated fat, trans fat in the food, will increase cholesterol levels. Saturated fats can make your cholesterol numbers higher, so better choose  diet that are lower in saturated fats. For instance,  red meat, butter, and cheese, have a lot of saturated fats.


Avoid tobacco: Stop smoking. Frankly, it may reduce the number of good cholesterol in your body.

Diet: Reduce the number of trans fats and saturated fat. Eat heart-healthy foods like fruits, vegetables, poultry, fish, and whole grains.  Limit red meat, sugary products, and dairy products made with whole milk.

Harvard Health has identified 11 cholesterol-lowering foods that can lower cholesterol levels:

  • oats
  • barley and whole grains
  • beans
  • eggplant and okra
  • nuts
  • vegetable oil like canola and sunflower
  • fruits such as apples, grapes, strawberries, and citrus
  • soy and soy-based foods
  • fatty fish like salmon, tuna, and sardines
  • foods rich in fiber

Exercise regularly: Try to exercise about 30 minutes per day, 3 times a week.

Lose weight: Hence, losing about 10% of your body weight can make a difference in your cholesterol levels. Get advice from your healthcare provider about the safe ways to lose weight.

Avoid negative emotions: Learn how to deal with anger, stress, and other negative emotions in your life even though is hard.

Control blood sugar and blood pressure: Make sure to follow your healthcare provider’s guidelines for blood sugar levels, especially if you have diabetes, to keep your blood pressure healthy.



There are ways to treat high cholesterol:-

Lipid-lowering therapy

Drug treatment for people with high cholesterol depends on their level of cholesterol and other risk factors.

Healthcare practitioners usually will advise to start with diet and exercise first, but people with a higher risk of a heart attack may need to take statins or other medications to treat their disease.

Statins are the leading group of cholesterol-lowering drugs. The statins available on prescription in Malaysia include:

  • Atorvastatin (Lipitor®).
  • Fluvastatin (Lescol®).
  • Lovastatin (Mevacor®).
  • Pravastatin (Pravachol®).
  • Rosuvastatin (Crestor®).
  • Simvastatin (Zocor®).

Statin medications are one of the most well-known categories of cholesterol drugs. Thus, statin work by reducing the amount of cholesterol produced by the liver. Furthermore, statins work to decrease blood cholesterol and may help reduce the risk of heart attacks and stroke.

Other drugs:-

Apart from statins, a doctor may prescribe:

1. Selective cholesterol absorption inhibitors

2. Niacin is a B vitamin that affects the production of fats in the liver.

3. Bile acid sequestrants are another class of drugs used to treat high cholesterol levels. Drugs, also called resins, are attached to bile acid, which cannot be used for digestion. In response, the liver makes more bile by using more cholesterol. These drugs shall include:

  • Cholestyramine (Questran®, Questran® Light).
  • Colestipol (Colestid®).
  • ColesevelamHcl (WelChol®).

4. Fibrates are also called as fibric acid derivatives. They are more effective at reducing triglyceride levels than LDL cholesterol. It  also helps to boost the levels of HDL cholesterol. These drugs include:

  • Fenofibrate (Antara®, Tricor®, Fenoglide®, Fibricor®, Lipidil®, Lipofen®, Trilipix® and Triglide®)
  • Gemfibrozil (Lopid®)

5. Omega-3 fatty acid medications derived from fish oils work to lower high triglyceride levels.

Apart from a healthy lifestyle, some medication helps to reduce the cholesterol level in our bodies. At mayflax, we provide pharmaceutical products to the customer. Cholesterol medication is also available like Crestor® and other drug brands. If you want to deal with us, you can contact us or sign up here for more info.


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Raihan Ridzuan

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


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The Pfizer-BioNTech Vaccine Covid-19

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The Pfizer-BioNTech Vaccine Covid-19

The Pfizer-BioTech vaccine COVID-19 help our bodies develop immunity to the virus without getting the illness. It usually takes a few weeks for the body to produce T-lymphocytes and B-lymphocytes after vaccination.

On December 11, 2020, the U.S. Food and Drug Administration issued the first emergency use authorization (EUA) for a vaccine for the prevention of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Therefore, a Covid-19 vaccine developed by Pfizer and BioNTech appears to protect against a coronavirus variant that spreads rapidly to others.

How the Pfizer/BioNTech Vaccine works?

Vaccine Covid-19 works?

Side effects

After vaccination, symptoms such as fever sometimes can occur during the immune building process. These symptoms are normal and are a sign that the body is building immunity.

Most common side effects:-

(i) In the arm where you got the shot:

  • Pain
  • Swelling
  • Redness

(ii) In your bodies:

  • Chills
  • Tiredness
  • Headache

Usually, these side effects begin within a day or two of receiving the vaccine. As well as, they may feel symptoms of the flu, and they may also affect the ability to do daily work, but don’t worry, the side effect will go away in a few days.

COVID-19 Vaccines Require More Than One Doses

As reported by the BBC, this specific vaccine requires two doses. Immunity starts to build in 12 days after the first jab. After 21 days, a second dose is required to allow the body to develop full immunity by day 28.

Doses of vaccine covid-19

Who should get vaccinated

  • The Pfizer-BioNTech vaccine is recommended for people 16 years of age and older.

Who should not get vaccinated

  • If you have had a severe allergic reaction such as anaphylaxis or an immediate allergic reaction, even if it was not severe, to any ingredient in an mRNA COVID-19 vaccine, you should not have received the mRNA COVID-19 vaccine.
  • Moreover, a person who had a severe allergic reaction which is anaphylaxis or an immediate allergic reaction, even if it was not severe, after receiving the first dose of the vaccine, you should not be given another dose of the mRNA COVID-19 vaccine.
  • An immediate allergic reaction within 4 hours after getting vaccinated, including symptoms such as hives, swelling, or wheezing.
  • People who are allergic to PEG or polysorbate should not receive the mRNA COVID-19 vaccine.

Vaksin Covid-19 Keluaran Pfizer (COMIRNATY®)

Bagaimana Vaksin Comirnaty bertindak dalam tubuh badan ?

Gambar Vaksin covid-19 bertindak

Kandungan Vaksin Comirnaty

Kandungan vaksin comirnaty

Apakah Kesan sampingan ?

Kesan sampingan vaksin covid-19

Dos yang diperlukan untuk Vaksin Comirnaty

Setiap individu perlu menerima 2 dos vaksin Comirnaty dengan tempoh masa sekurang-kurangnya 21 hari di antara dos pertama dan dos kedua.

Individu yang boleh mendapat suntikan Vaksin Comirnaty

Semua individu yang berusia 18 tahun ke atas boleh mengambil vaksin Comirnaty di Malaysia.


Individu yang tidak sesuai untuk menerima Vaksin Comirnaty

Vaksin Comirnaty tidak sesuai diberikan kepada individu:

  • Mempunyai sejarah alahan yang serius seperti anafilaksis, terhadap makanan/ubat/persekitaran sehingga memerlukan rawatan hospital.
  • Individu yang mengalami alahan yang serius selepas menerima dos pertama vaksin Comirnaty.
  • Menjalani pemindahan organ seperti buah pinggang atau sel stem darah dalam masa 3 bulan sebelum divaksinasi.
  • Menjalani rawatan kanser seperti kemoterapi, radioterapi, imunoterapi.
  • Mengidap penyakit HIV dengan sel darah putih CD4 < 200 cells/mL
  • Ibu yang mengandung atau merancang untuk hamil
  • Demam disebabkan jangkitan virus atau bakteria
  • Menerima rawatan antibodi monoclonal atau plasma darah sebagai rawatan untuk COVID-19 dalam masa 3 bulan sebelum divaksinasi
  • Mempunyai sel darah platelet yang rendah (< 50,000 per microlitre)

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Raihan Ridzuan

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


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Depression and Anxiety During a Pandemic: 9 Common Tips

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Depression and Anxiety During a Pandemic: 9 Common Tips

The pandemic has caused a mental strain on many people around the world. And for those living with anxiety and depression, the impact is severe.

The COVID-19 pandemic has had a major effect on our lives. Many aspects of everyday life, including mental health, have been affected. The COVID-19 pandemic is impacting our physical, economic, and mental well-being. As a result, many people face struggles that can be frustrating, daunting, and cause adults and children to have strong emotions.

However, social distancing and stay-at-home orders are very challenging, especially for people living with mental illness, COVID-19 exacerbates feelings of depression and anxiety.

Thus, during the Movement Control Order (MCO), with the limited movement, closed borders, and roadblocks, some individuals easily get heightened temperament and irritability at home.

Dr. Robert Leahy an attending psychologist at New York-Presbyterian said: “This is the perfect storm for depression and anxiety,”.

All data and statistics are based on the short article “Prevalence  of  Anxiety, Stress,  Depression  among  Malaysian  Adults during COVID-19 Pandemic Movement Control Order”.

Therefore, the  prevalence  in a score  of Stress  70%  (Mean=2.02), Anxiety  67%  (Mean=1.71) and Depression  42.3% (Mean=2.28). There is a significant prevalence of psychological health problems among adults during adverse events due to the COVID-19 Pandemic Movement Control Order.

In the midst of the global COVID-19 pandemic, it’s easy to felt hopeless and despair. But these tips can help to improve your mood and ease your mental health problem.

1. Keep a schedule

Schedule your day with useful things. At the end of the day, check everything and make a list of things to do for the next day, so you can look forward to things.

Furthermore, create a set of goals for the week and month. This is the right time to set short-term and long-term goals.

2. Sleep well

Prioritizing sleep is not always easy when you are in a state of mental health. Stress, Anxiety, and Depression can affect the quality of your sleep.

Therefore, poor sleep can also lead to depression. Fixed your daytime habits and sleep routine can help improve how well you sleep at night and reduce the symptoms of depression.

Finding relaxing activities such as reading, writing a journal, or listening to slow music can cause your brain to slow down before bed.

3. Connect with others

Just because we are isolated does not mean we have to completely isolate ourselves. Make a list of friends to contact whenever you feel bored and lonely. Always stay connected with others !

Set a regular time each day to contact others, and schedule virtual get-togethers on online platforms to talk or share your problem and maybe even play games. Stay in touch with friends, family, and especially the mental health care team if you are diagnosed with anxiety and depression.

4. Find simple sources of joy.

Encourage yourself to do things that will boost your mood throughout the day. Try to listen to uplifting music and dancing around if you can as long as can make you happy all day long.

Alternatively, you can watch funny videos or favorite sitcoms on TV, Instagram, Facebook, or YouTube. Spending time in nature such as walking in the park, or playing with your kids or a pet also can relieve stress.

5. Eat a mood-boosting diet

In times of stress, people always find “comfort foods” such as unhealthy fats, sugar, and refined carbs to release their stress and depression. Therefore, drinks too much caffeine and alcohol also can adversely affect our mood.

Moreover, wholesome foods, fresh food such as salmon, codfish can increase your intake of mood-enhancing nutrients.

6. Stay informed and limit social media usage.

Nowadays, the government always announces information that constantly changes regarding SOP. It is important to stay up-to-date but not to overconsuming sensationalistic news or unreliable social media coverage. This makes your mind full of negative thought and fear.

Limit how often you check the news or social media and limit yourself to reputable sources. Thus, healthcare professionals also recommend not checking the news at least one hour before bedtime.

7. Exercise

Importantly, physical activity is good for mental health. Scientific research has shown that exercise, especially in particular aerobic exercise, can be beneficial for depression and anxiety.

Exercise will release good hormones and lowers your stress hormones. Since covid-19, you cannot go to the gym or fitness studios, try online broadcasts, YouTube workouts, or use the equipment at home to exercise.

Besides that, you can go running or cycling as long as you stay a safe distance away from others who are passing by.

8. Continue treatment or services from mental health professionals

If you are undergoing therapy, taking medication, or both before coronavirus started, make sure to keep up with your treatment regimen. Almost all psychiatrists or mental health professionals are now used online practices like video calls.

Alternatively, you can try an online therapy platform like WhatsApp video, Zoom, Webex, and others.

9. Practice gratefulness and mindfulness

During challenging times, be grateful and mindful can help to cope with anxiety and depression.

“When we take note of the good things in our lives, it bumps up the feel-good hormones of serotonin and dopamine,” said Serani.

As we know, practicing mindfulness meditation is very popular for overcoming depression, anxiety, and stress adds Guttentag.

Also, you can start the practice by taking a few minutes to sit or lying down and try to focus on your breathing. Besides, train your mind to get rid of negative thoughts and feelings to stay away from you.

Counseling and hotlines mental health services in Malaysia

If you are struggling to cope, there are many ways to get help. Contact a healthcare provider if the sign of anxiety, and depression get in the way of your daily activities for many days and also if you are in crisis, immediately get help such as:-

  • Call 999
  • Talian Kasih at 15999
  • Befrienders (main suicide hotlines in Malaysia): 03-7627 2929/ 03-79568145
  • Malaysian Mental Health Association: 03-2780 6803
  • People Psychological Solutions : 017-899 2207
  • HELP University’s Centre for Psychological and Counselling Services (CPCS): 03-2096 1212
  • The Mind Faculty KL: 03-2780 6803
  • HumanKind Community Counselling (victims of physical and sexual abuse): 012-300 5453
  • Soul Mechanics: 010-252 1734 (Gia) / 019-395 9211 (Devi)
  • MentCouch Psychology Centre: 03-2712 9372

Depression and anxiety are soaring and there are many fears that we will face an epidemic of mental health.

COVID-19, make life very difficult for everyone, but they may pose an even bigger challenge for people with depression. Depression is a serious mental health condition that can give a huge impact on people’s lives.

However, depression can be treated. Even in this pandemic, it is important to continue to seek treatment and stick with it until you get cured.

Therefore, there are self tests that you can answer to check whether you have anxiety or depression, if the score tells you are having these mental health issues you need to see the doctors who specialize in psychiatry to diagnosed your disease. We cannot simply just do the test only. These self tests ask some important questions that can help you to know where you are at so you can make a sooner plan for feeling better.

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


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Improper Inhaler Technique: Affect Asthma Control

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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)


  • 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?

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

Available Brand in Malaysia

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

2. Tuberhaler


  • 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?

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

Available Brand in Malaysia

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

3. Respimat soft mist inhaler


  • 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?

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

Available Brand in Malaysia

  • Spriva Respimat® (Tiotropium)

4. Accuhaler


  • 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?

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

Available Brand in Malaysia

  • Seretide® Accuhaler (Salmeterol/Fluticasone)

5. Ellipta


  • 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?

  1. First, check dose counter and do not shake.
  2. Second, slide cover down until click is heard.
  3. Third, breathe out away from inhaler.
  4. Fourth, put mouthpiece in mouth and close lips to form a good seal;
  5. And do not block air vent with fingers.
  6. Then, breathe in steadily and deeply.
  7. Fifth, hold breath about 5 to 10 seconds.
  8. While holding breath, remove inhaler from mouth.
  9. After that, breathe out gently, and away from inhaler.
  10. Slide the cover upwards as far as it will go, to cover the mouthpiece.
  11. 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)
Picture of taking ellipta

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. 

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Author picture.Mayflax

Raihan Ridzuan

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


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