Expert Answers: Common Mistakes When Using Inhalers
A common question in our community revolves around the use of inhalers for COPD - specifically, how to use them correctly. So we asked our expert respiratory therapists, John, Leon, and Lyn to answer this question on behalf of the community:
What are some common mistakes when using inhalers? How can I correct them?
First, let me say that nearly all mistakes made when using rescue inhalers can be eliminated by using a spacer. In fact, when used with a spacer, studies show inhalers work just as well as nebulized medication with fewer side effects. The most common mistake with spacers is inhaling too fast. Generally, you will want a smooth, laminar flow, so a slow and deep inhalation is required. Some spacers whistle when you inhale too fast, and this is a nice teaching tool: if you hear a whistle, inhale slower next time. Another common mistake is not rinsing after each use. Rinsing is important to prevent you from swallowing medicine particles left in your upper airway, and to prevent systemic side effects. The best COPD physicians will have you demonstrate proper inhaler technique in the office to assure you are using it correctly and obtaining an optimal dose.
Many different kinds of medicines are prescribed and taken by patients with COPD that require the use of an inhaler. These inhaled medications go directly to the site of inflammation and constriction in the airways instead of traveling through the bloodstream to get there. Inhaled medications only work if they get to the airways, so their proper use is essential if they are to be effective. Between the metered dose inhalers (MDI's) and dry powder inhalers (DPI), instructions and techniques can vary and be confusing for patients.
The use of these inhalers is not necessarily intuitive and many people do not use their inhalers properly, so the medication does not reach their airways as effectively as it should.
Some common mistakes and specific recommendations when using inhalers include:
- Difficulty with hand-breath coordination (make certain to exhale completely before actuating the inhaler at the beginning of inspiration).
- Breath hold at the end of inspiration is too short (try to hold your breath at the end of inspiration for at least 5-10 seconds).
- Inspiratory flow during inhalation is too rapid. (It is important to inhale slowly and deeply when you release the spray, so that you do not choke on the sudden burst of liquid. Try to breathe as calmly and as deeply as possible, filling up the lungs completely).
- The shaking of the inhaler is inadequate (make certain to thoroughly shake up the inhaler/canister prior to use).
- Multiple actuations for a single breath (only actuate the inhaler one time for each inspiration)
- Actuating the inhaler at the mouth, but inhaling through the nose (inhalers are designed for use through the mouth)
Other tips are:
- Avoid spraying the medication on the back of your throat and inhaling afterwards. This pretty much negates any beneficial effects the medication can provide, be that a bronchodilator or a corticosteroid.
- If you have trouble matching the timing due to breathing difficulties, you might want to use a spacer that will enable achieving the same effects without having to time your breathing.
- A calm, relaxed and slow exhalation is the key to allowing the medication to stay where it is needed most. If you have trouble performing deep, slow breaths, you can review several breathing techniques that can make this task a little easier. Here is a link to pursed lip breathing on COPD.net.
These are the more frequent issues reported by health care providers when observing patients using inhalers. Should you have concerns about whether you are using your inhalers properly, you should demonstrate your technique to your physician, pharmacist, or other expert health care provider for guidance.
It may be helpful to access this video for instructional purposes and demonstrations. It covers most of the various types of inhalers in use.
Since you want to get the most benefit from any medication you’re on, it’s important to use them properly – this is especially true of Metered Dose Inhalers (MDI’s). With almost all MDI’s you should use a spacer (dry powder inhalers such as Advair or Spiriva do not need one). When used without a spacer, most of the medication from your inhaler ends up in the back of your mouth, instead of your airways and lungs. Your doctor or pharmacist can recommend one that’s right for you. After you take your medication, try to hold your breath and count to 10 – this allows the medication to get further into your airways. There a quite a few helpful videos on YouTube demonstrating the proper technique for using an inhaler – I often point patients to these as they’re simple and easy to follow.
How about you? What's your experience with using inhalers for COPD treatment? Please share with us in the comments!
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