The British Lung Foundation state that 8 million (12% of the population) people have been diagnosed with asthma and other lung related diseases. Asthma UK states that the number of people receiving treatment for Asthma is 5.4 million. (database figures 2012)
Take a moment to think about how many inhalers are produced, how many are collecting dust or sitting at the bottom of your bag, how many are out of date and how many do you have?
Now consider the idea that 50% or 2.7 million people do not know how to use their inhaler or use it incorrectly. According to an Asthma nurse incorrect inhaler technique result in unmanageable asthma and unnecessary increases in dosage.
I remember when my inhaler was capsule based, you would have to place a small plastic capsule containing salbutamol powder into the inhaler which I would have to rotate to break the capsule and then inhale. Thank goodness for the school nurse who would prepare it for me. The capsules were not waterproof so they would start melting with wet or sweaty hands, trying to use it in the rain was impossible because you ran the risk of damaging your whole supply.
Thankfully inhalers have developed a long way since then, they are more efficient and easier to use. The three main common inhaler types:
PRESS AND BREATHE METERED DOSE INHALERS (MDIS)
An MDI inhaler uses a small canister with a mixture of your medicine and a gas or liquid that turns the medicine into a very fine spray as you press on the canister. Most people call this a ‘puff’ of medicine. These kinds of inhaler are often called ‘puffers’.
Spacers make press and breathe inhalers easier to use and more effective. They collect the medicine inside them, so you don’t have to worry about pressing the inhaler and breathing in at exactly the same time.
To get the best result you should shake the inhaler before each puff so that the medicine mixes well before use.
BREATHE IN NORMALLY BREATH ACTUATED MDIS
Breath-actuated MDIs are usually given to people who have difficulty using a standard ‘puffer’. These inhalers are activated by your breath.
When you breathe in normally through the mouthpiece, it releases medicine in a fine spray form. You don’t have to push the canister to release a dose.
Autohaler and Easi-breathe are examples of breath actuated MDIs. You need to shake these inhalers before each puff so that the medicine mixes well before use.
BREATHE IN HARD’ DRY POWDER INHALER (DPIS)
Dry powder inhalers release medicine in very fine powder form instead of a spray when you breathe in through the mouthpiece.
You need to breathe in fairly hard to get the powder into your lungs.
Examples of DPIs include Accuhalers, Clickhalers, Easyhalers, Novolizers, Turbohalers, Diskhalers and Twisthalers.
Although there are various different inhalers the main technique remains the same throughout most inhalers,this is where the issue lies. Having ‘bad’ or incorrect technique will result in the medication not getting into the lungs and just staying in the mouth rendering it ineffective.
Leading into the another problem, as asthmatic who believes they are taking their medicines; but are not getting better, or controlling their asthma goes to the doctors, the doctor then increases the dose or introduces an additional inhaler. No one is to blame in the situation, I am simply giving an experience and trend that I have seen, it becomes a cycle that overlooks what could potential be the reason for such high numbers of uncontrolled asthma is adults.
The foundations of good technique are vital:
- shake your inhaler,
- breathe out first
- form a tight seal around the mouthpiece
- breathe in correctly when taking the medicine
- hold your breathe
Each inhaler will have specific recommendations on techniques, but these simple rules are normally required in most inhalers.
I always follow my inhalers with a sip of water, or a mouth rinse as some inhalers can increase the risk of mouth ulcers.
I hope this blog brings to light a concern I feel very strongly about, whilst admitted in Hospital I have witnessed adults with life long asthma use their inhalers incorrectly, thus losing faith in the medication and becoming content with the limitations asthma can have on their lives.
I have been involved with several on-line discussions based upon medicines that do not help asthma. This is simply incorrect, medicines/inhalers do work, they just need to be used correctly.
I think more should be emphasised on the techniques of inhalers, as early as possible this will create better medicated asthmatics who understand how the medicine works and where is needs to be, this will lead to a lower dose, working better for the asthmatic lower dose means lower side effects.
More should be done at schools, and asthma check ups/reviews should revise techniques. I am hoping to go into schools to talk about this matter.
If you would like me to come to your school or workplace to talk about asthma inhaler technique please contact me via email to discuss this further.
Thank you for your time, I hope this helps you or someone you know.
Take a breathe,