Bronchodilators are common treatment options prescribed by physicians treating patients suffering from chronic shortness of breath. Despite their widespread use, however, a significant percentage of COPD patients do not use their inhalers properly. The result of the misuse is inhalation of either too-little or too-much medication. In either case, patients can become frustrated with the effectiveness and/or side effects of the medications.
This widespread misuse is somewhat understandable given that there are different types of inhalers which carry different usage instructions (dry powder inhalers, metered dose inhalers) and some incorporate nebulizers while others don’t. Further, despite the best efforts of respiratory care professionals, many patients report they do not receive adequate instruction on how to use them properly.
As a case in point, a new study abstract published online ahead of print in the Journal of General Internal Medicine, examined the inhaler use of 40 COPD and 60 asthma patients who had been hospitalized due to their conditions at one of two Chicago area hospitals. The researchers discovered that 86% of the study subjects were improperly using metered dose inhalers while 71% were misusing Diskus brand dry powder inhalers. [1]
The study authors cited two main reasons for the poor rate of correct usage – difficulty with vision, and low health literacy. 43% of the COPD patients in the study had vision worse than 20/50 in both eyes. 61% of COPD patients in the study scored “less-than-adequate” health literacy on a test called The Short Test of Functional Health Literacy in Adults (S-TOFHLA for short).
After administering the vision and health literacy tests, the researchers taught patients the correct methods for using the inhalers (and presumably practiced with them). At the end of the study 100% of the participants correctly used their inhalers. The research team concluded the abstract by acknowledging, “Inhaler misuse is common, but correctable in hospitalized patients with COPD or asthma. Hospitals should implement a program to assess and teach appropriate inhaler technique that can overcome barriers to patient self-management, including insufficient vision, during transitions from hospital to home.”
If you think you might be using your inhaler improperly, the simplest of solutions is to visit your physician/pulmonologist/respiratory therapist and ask them to demonstrate the proper technique. Practice it in front of them to ensure you’ve got it down right and in future office visits, every now and then ask them to evaluate your inhaler technique.
Here is a brief excerpt from our Breathe Better for Life guidebook regarding proper use of metered dose inhalers:
“Many COPD medications need to be inhaled deeply into the lungs. Most people, over 90%, misuse their inhalers. To help you do this effectively, you will most likely need to use a metered-dose inhaler (MDI). If you have an MDI without a spacer, you need to shake the inhaler to prime it. Remove the cap and exhale deeply. Hold the inhaler one to two inches from your mouth (do NOT put it in your mouth). Press down to discharge the medication as you breathe in as deeply as you can. One depression (spray) per breath. Close your mouth and hold your breath for 5–10 seconds (ideally). Then exhale slowly.
If your MDI has a spacer, you want to shake the inhaler to prime it, then attach the spacer. Exhale deeply, then put the spacer between your teeth and seal your lips around it. With your chin up, pump one puff into the spacer. Slowly inhale through your mouth for three to four seconds. (Too rapid of an inhalation will likely result in less medication getting to the lungs, where it is absorbed and utilized by the airways.)
Remove the spacer from your mouth, and with your mouth closed, hold your breath for 10 seconds (ideally). Then exhale slowly. If you take a second puff, wait at least 30 seconds before doing so.”
If you’d like a more robust explanation and demonstration of the proper use of inhalers, our Breathe Better for Life companion CD-ROM includes easy-to-understand pictorial, narrated, step-by-step instructions on the proper use of metered dose inhalers, dry powder inhalers and nebulizers. As many of you know the Breathe Better for Life guidebook and CD-ROM also contains specific exercise, nutrition, breathing technique and airway clearing technique recommendations and demonstrations. You can learn more about Breathe Better for Life by visiting www.breathebetterforlife.com.
[1] Press VG, et al. Misuse of Respiratory Inhalers in Hospitalized Patients with Asthma or COPD. J Gen Intern Med. 2011 Jan 20 [Epub ahead of print]
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