How do I properly use my dry inhaler?

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Dry Inhaler

Dear Coach,

I just finished a pulmonary rehabilitation class and noticed today that my incidence of shortness of breath had decreased. However, I am still having trouble inhaling my new dry powder long acting inhaler. Everyone teaches pursed lip breathing, but what exercises will help with taking deep breaths through my mouth? I feel like I do not get the dry powder into my lungs and it only stays in my mouth.

Powder Puff

Dear Powder Puff,

As COPD progresses it is often difficult to take deep breaths. While it may seem counter-intuitive, COPD is actually a disease that limits your output of air, not taking it in. Until you can successfully empty your lungs, you will not be able to take as much air in; kind of like you can only fill a glass so far. Pursed lip breathing does help empty your lungs and it also helps rid you of excessive CO2 buildup. I also do a modified version of pursed lip breathing where I take a large breath through my mouth and slowly try emptying my lungs as much as possible. At first, I find I can only exhale a small volume but with continued tries I find I am progressively taking deeper breaths. I do this several times a day. This may not work with everyone because it would be dependent on how severe your disease process is; also, because of hyper-inflation of the lungs the breathing muscles aren't nearly as effective as they could be.

As for dry powder inhalers; they can be problematic for many as they just don't have enough lung function to get the powder where it needs to be. What I find that works for me is: first I do the open mouth breathing exercise or pursed lip breathing first and then instead of holding my mouth tightly around the inhaler, I hold my mouth a little looser around the mouth piece and "huff" in the medication then follow by immediately taking as many follow-up huffs as I am able before taking in another breath. I want to stress that there is no scientific evidence to prove that this works but I can say it works for me.

Another thing I have tried that is effective (and recommended by my doctor) is I use a bi-pap set to high settings (also recommended by my doctor) 20 minutes in the morning and twenty minutes before bed before using my dry powder inhalers. Interestingly enough, I had a problem with waking up during the night feeling out of breath and this pretty much solved it and I generally felt like I was able to take deeper breaths afterwards.

Hope this helps,

The COPD Coach

7 Comments

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Tracie Sullivan

Thank you for another great article COPD Coach!
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Gina Bradshaw-Arkansas State Captain

Thank you for your insight on the inhaler.
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Bill66 - Bill Wornstaff NJ State Captain

You do have to concentrate before using the dry inhaler, it's nothing like just swallowing a pill, If you dont pay attention you'll have a mouthful of powder.
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Ashok PLB

I was faced with the same problem when I shifted from my maintenance MDI inhaler to a corresponding dry powder inhaler. I take a few puffs of the MDI emergency inhaler through the spacer. That opens up the bronchial sacs. I follow it up with five minutes of PLB. This helps me to calm down and concentrate. Then I suck in the dry powder and hold it in for a count of ten
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- Ashok PLB
  
  I have just come back from the hospital after facing an exacerbation. I tried to use the dry powder inhaler, but my lungs just don't seem to have the capacity to suck in the powder. It ends up in my throat. So am nebulizing instead presently. Have ordered a MDI inhaler to replace the powder, can use it with the spacer at this condition of the lungs. That will work out fine. 😃
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Scott Cerreta, BS, RRT

There was a lot of discussion at the AARC conference about this topic. Dr. Ohar and colleagues published a paper that described an inspiratory flow of 60 Lpm is required to operate a DPI. The drug is attached to inert substances within the powder. A strong inspiratory force is required to break the drug free from the inert substance so it may travel into deep parts of the lung. Suboptimal peak inspiratory flows (sPIF) are linked to increased exacerbations and hospital reAdmissions. The other methods described here like a huff maneuver will not generate optimal peak inspiratory flows (oPIF).

There are a couple devices on the market that measure PIFs. This tool is emerging and if you menition it to your RT or rehab center, they likely will not have a clue. These tools are an In-check dial and the AIM, produced by Vitalograph.

Ashok, did the right thing. If you do not feel like you are getting medicine out of your DPI, then you likely are not. You should switch to a medication in the same class that comes in a device that you are able to use properly.

Scott.
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- Bill66 - Bill Wornstaff NJ State Captain
  
  Great follow up post Scott, Ashok's input about dry inhalers can help many people. Bill66
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