Ah…the inhaler. There are SO many different medications (now-a-days) that come in a variety of portable devices; the aerosol, dry powder, soft mist, long-acting/short-acting bronchodilators, steroids, etc. Always, always follow the directions/instructions that you are provided for your medications as quantity, frequency, and type of medication routine is individual; what your friend does is not necessarily what you should do. Also, if you don’t understand how to use your ‘device’, ask the pharmacist or call your provider’s office and get the answers to your questions. I have (too many) patients that come in and, over discussing or demonstration, I find that they are either not taking their meds correctly or they ask me because they are not sure. I cannot, without the medication or instructions, tell anyone exactly how they should be taking their home meds – I can only give generic information. And this is a good place for a link; I don’t usually do this but I found this one and it has some very basic information for some types of inhalers, not all; Communitycarenc *use the link to go directly to the inhaler devices. Also, learn the name of your device – it’s helpful when asking questions of someone who doesn’t know what you take; an “mdi” isn’t the same as a “diskus”.
Don’t rush through taking your breathing medications! It eludes me how impatient some people can be with this routine – it’s for you to breathe more easily, you know…to stay alive? Why hurry through the process, thereby, not getting the most from your (expensive) medications? Make taking your respiratory medication as thorough (and enjoyable) as you might find drinking your favorite morning beverage; keep a good schedule and make it as convenient as possible so you’ll stick to it and not ‘forget’ such as morning and night (before) brushing your teeth or taking other a.m./p.m. medications, middle of the day – around lunch time, or multiple times a day – make it around the same time as other routines. By ‘enjoyable’ I mean think in terms of taking your respiratory medications for your lungs similar to eating food for your body: you need it so teach yourself to appreciate it while taking it. A good time to use a breathing technique is while taking an inhaled medication. I know this may sound idiotic but I notice that some people take their medications begrudgingly, like they resent the fact that they need it – this isn’t a healthy perspective, not good for the soul. We are fortunate (that we/if) we have medications that keep us healthy and functioning at our best.
And now for some inhaler basics: When I am giving instructions on how to take inhaled medications I try to get people to think/visualize about what they are doing, what the body is doing, so the process makes sense, thus, easier to remember. In order for medications to be the most effective, you have to get them into the lungs where it binds with receptors in order to work. What that means is several techniques make this optimal.
A. First you need to exhale before inhaling meds: think about it, if you want your meds to go as deeply into your lungs as possible, you need to take a deep breath and, in order to do that, you need your lungs more empty than full. I’m not saying exhale as much as you can (although some people really like to take their time and exhale fully and that’s okay I’m just saying you don’t have to) but do try to exhale a little more than a typical exhaled breath. Then hold until you have your med/mouthpiece in your mouth before inhaling.
B. Place the mouthpiece of any device between teeth. I see so many people pucker up and place the mouthpiece to their lips, like they’re kissing it. You want an unobstructed route for the medication particles to get to your lungs – place it between your teeth (or gums) and close your lips around the mouthpiece.
C. Inhale deeply, slowly and steadily. Note: I’m giving generic information so follow your mediation instructions because some medication instructions (e.g. twisthaler) state to inhale “fast” and I’m not contradicting those. If you are using a spacer* device (and I always recommend using one unless your inhaler doesn’t allow for it), there will be a whistle or a ‘harmonica’ sound when you are inhaling too fast. The reason for inhaling more slowly is to create laminar flow versus turbulent flow. Your airway has all kinds of surfaces such as the teeth, tongue, tonsils, uvula, musculature, etc. and you want your medication particles to flow smoothly into your lungs. The faster you inhale, the more turbulent that air flow is and within turbulent flow those particles ‘swirl’ around and land on the airway surfaces instead of getting into the lungs. Think in terms of water: a slower moving stream of water flows over surfaces more smoothly but a faster flow of water, such as a fast moving river, ‘crashes’ into surfaces such as rocks and creates the whitewater rapids with spraying water. Sometimes you might notice, if you inhale ‘too’ quickly while taking meds, that you cough, that’s due to turbulent air flow, particles landing on surfaces in your upper airway – causing the cough and, in effect, expelling that medication that you just inhaled; counter-productive.
D. Breath hold. Your airways are naturally moist (as observed when you exhale onto glass or a mirror) and a little breath hold, just 3-5 seconds, when you’ve inhaled medications allows those particles to deposit in the airways.
E. Exhale and wait just a little before your next inhalation of medication. You may hear that ‘you don’t have to wait‘ – and maybe you don’t have to…but, in terms of getting the most out of your medication and making it a positive and healthy routine not to be rushed through, a little pause before the next deposition of medication can’t hurt. In some cases, waiting is necessary: logically speaking, if you are taking a bronchodilator (to open your airways) waiting in between puffs allows the medication to start working so the next puff can go more deeply **OR if you take multiple inhalers and your provider hasn’t specified what order to take them (or they say it doesn’t matter), you want to start with the bronchodilator (e.g. proventil, ventolin): it makes sense in terms of opening your airways first and, if possible, waiting maybe 15 minutes before subsequent medications so they can get deeper into your lungs.
F. Follow the directions for cleaning the device (including spacer). Many people do not do this. All inhalers deliver particulate matter (medication) usually through a small opening (depending on the device) and those openings can become clogged with said particulate if not cleaned as directed.
Well folks, I’ve been sitting far too long; my hands are cold, my ass is numb and my eyes are blurring and I still have today’s “N” to write. I hope you found this informative and, as always –
*Spacer will be discussed with “S”