Teaching with a Twist – Inhalers

This article was written by Stephanie Williams, BS, RRT. Stephanie is the Director of Community Programs and Volunteer Management for the COPD Foundation.

As a respiratory therapist I have a love/hate relationship with inhalers. The thought of having a month’s supply of respiratory medication in a portable delivery system is great and they can be incredibly helpful to people with a variety of health conditions Notice I didn’t say that they are easy to use? The idea is a great one, but research shows that approximately 94% of people don’t use their inhalers correctly. Part of the problem is that there are different methods for each different type of inhaler on the market.

There are 13 inhalers commonly prescribed for COPD. You may have had a variety of them prescribed to you at different times as your doctor was trying to find the right treatment plan for you. With so many different medicines available, there is a lot of potential for people to use them incorrectly. Think back to a time when you were prescribed a new inhaler. Were you educated about what the medicine was being prescribed for? Did someone instruct you on when you should take the medication? Were you shown, and then encouraged to demonstrate, the proper steps to activate the inhaler with maximum effectiveness?

Let’s go through some of the ways that these medications are used incorrectly.

1. Taking the wrong medication at the wrong time. Because of my profession, I notice when people out in public use an inhaler. My children live in dread of those moments. They dread these moments because they know that I will most likely approach that person and engage them in a conversation about their medicine, the technique they use, how often they use the medicine … among other things. You might be surprised at how many times I have talked to someone who didn’t know the difference between their rescue and maintenance inhalers and used them interchangeably. This may seem so basic that it doesn’t need mentioning, but this is actually a widespread problem for inhaler users. There are two basic types of inhalers:
   1. Maintenance inhalers should be taken at or about the same time every single day. You may not feel that the medicine is helping, or you may not see a drastic improvement, but these medicines may be making more of a difference than you realize. The idea is they will provide a daily treatment that will help keep symptoms under control without the frequent use of your rescue inhaler.
   2. Rescue inhalers are for those times when you need to open up your airways and increase the airflow in your lungs. If you notice that you are using your rescue inhaler more frequently than normal, this could be a sign of an exacerbation and you should contact your doctor. This follows the guidelines in the My COPD Action plan found here.
2. Not exhaling completely before inhaling the medicine or exhaling into the device. In order to be able to draw the medicine down into the lungs, it is essential to be able to take a nice deep breath. The only way to get a deep, full breath is to make sure your lungs are empty first. Exhale completely before putting your mouth to the inhaler so that you can inhale all the available medicine into your lungs.
3. Failing to prepare the device properly. Some inhalers have to be shaken, some have to be primed, some have to have capsules inserted and punctured – the list goes on and on. It can be confusing and hard to remember which ones need to be prepared a certain way. Here is a link to some instructional videos to help you learn how to take the different inhalers properly. These are very informative and can show you step by step how to use the inhalers as they are designed.
4. Being unfamiliar with new devices. In the past few years, some companies have designed new types of inhalers which were created to increase the effectiveness of the dispensed medicine. They do this by providing a longer-lasting mist so that the person doesn’t have to be quite as coordinated with the device and a quick breath as they would a normal spray inhaler. There are other devices that require certain parts to be turned and twisted before the medication is available to be inhaled. Failure to perform the required steps will keep you from getting your dose of medicine. You may “think” you have taken your medicine, but, in fact, you didn’t at all. The video series mentioned above would be very helpful in learning or reviewing how to use these new devices properly.
5. Using an empty inhaler. A few years ago, respiratory therapists had to encourage people to make a mark on the side of their device every time they took a dose so they would know how many puffs they had left in the canister. We taught people how to put the device in a cup of water and tell if it was full or empty by whether or not it floated. Today, most of these devices have dose counters that indicate how many doses are left to be used. Even so, it is surprising how often people will use an empty inhaler. Keep an eye on your remaining doses. This is an easy thing to do to make sure you get the medication that will keep you breathing easier.

I hope you will take some time and watch the inhaler video series to learn or review the proper techniques for the inhalers you use. They are available for viewing any time you need help or just can’t quite remember if you are doing it right.

Fair warning: if you use your inhaler in public and a dark-haired lady approaches you asking questions about your inhaler knowledge, it is probably me. Then look around for my family. They will be the embarrassed group behind me at a safe distance. In that event, you will get a little inhaler education and my family will be embarrassed. To me, that’s a win/win!

Now for the Twist!

Let’s play a game of word associations. I will give a word to start, and then each person will list another word that is associated or a word they think of when they hear the previous word.

Example: Salad

• Person 1 - Caesar
• Person 2 - Rome
• Person 3 - Empire
• Person 4 – TV and so on…

Ready??

The word is balloon. Let’s see how far we can go!