Why is Inhaler Technique important in Asthma?

Inhaler is a medical device used to deliver medicine into the lung. These are the most effective and safe drugs to treat asthma.  Contrary to the common belief, inhalers are non habit forming.

Studies show that up to 80-90 % of patients use their inhaler incorrectly.

Incorrect inhaler technique leads to increase in use of emergency medicines, worsening of asthma control, non compliance with medications.

According to asthma guidelines inhalers should only be prescribed after patients have received training in the use of device and have demonstrated satisfactory   technique.

Different types of inhalers are available in the market. Choice of inhaler depends on various factors including   patient’s age, inspiratory flow, ability to coordinate and patients own preference.

Use of Spacer devices

Spacer devices are recommended   to improve inhaler technique with MDI (metered dose inhaler), and to increase drug delivery and reduce oral thrush.

Spacers are plastic device with mouthpiece or mask at one end, and place to insert inhaler at other end.  Spacers give patient more time to inhale the medicine, better coordination, and prevent escape of medicine into air.

Spacers are especially useful in younger children.

These devices require proper cleaning and regular change as per manufacturer’s recommendation

Use of spacer helps to take inhaler medication more effectively

Steps for taking inhaler (MDI) with spacer

1. Take off the inhaler cap and hold it upright.
2. Shake the inhaler well. If the inhaler is being used for the first time or if it is used after a long interval of time then 3-4 sprays should be released into air before using it.
3. Put the inhaler into the open end of your spacer.
4. Put the mouthpiece between your teeth and lips, making a seal so that medicine cannot escape.
5. Sit or stand up straight.
6. Press the inhaler canister once to release the medicine.
7. Breathe in slowly and steadily until your lungs feel full.

8. Remove the mouthpiece, hold your breath for up to 10 seconds, or for as long as you comfortably can. Then breathe out gently.

Breath actuated inhalers

In patients who have difficulty in coordinating, breath actuated inhalers can be used.

These devices deliver the drug automatically when they sense that patient is breathing in through the mouth piece.

Dry powder inhaler (DPI)

A dry powder inhaler (DPI) is a breath-actuated device that delivers the drug in the form of particles contained in a capsule or blister. They can be single dose or multiple dose inhalers.

These devices are recommended for patients who can take a deep and fast breath.

Steps to use DPI

1. Load the inhaler with medicine dose
2. Stand or sit up straight
3. Breathe out completely
4. Put the mouthpiece between your teeth and lips, making a seal so that medicine cannot escape.
5. Breathe in quickly and forcefully.
6. Take the mouth piece out , hold breath for 5-10 seconds and then slowly exhale
7. In case of capsule device, check if the capsule has been fully inhaled. If some powder is left , then repeat the above steps

I would like to conclude by saying that technique of taking inhaler is of utmost importance while managing patients with asthma and it should be reinforced every time patient visits the doctor.

Useful links:

1. https://www.pharmaceutical-journal.com/cpd-and-learning/learning-article/how-to-help-patients-optimise-their-inhaler-technique/20201442.article
2. https://www.nursingtimes.net/clinical-archive/asthma/how-to-teach-inhaler-technique-26-02-2011/
3. https://www.allergyasthmanetwork.org/education/asthma/treatment-and-medications/how-use-dry-powder-inhaler-dpi/