How good is your inhaler technique? According to a study published in the Annals of Allergy, Asthma and Immunology earlier this year, 93 percent of asthma patients had flaws in their inhaler technique. That’s right, only 7 percent got it all right. The most common misstep was failing to exhale completely before inhaling the medication.
The study reported on 44 pediatric and adult asthma patients from an allergy practice in Galveston, Texas. More than half the patients did not fully breathe out before inhaling their asthma medication. Other flaws included inhaling too fast through the spacer device, and not shaking aerosol inhalers before the second puff (it’s important to shake most aerosol inhalers several times before each puff).
Spacers are long plastic tubes used as brief holding chambers for aerosolized asthma medication. They have a mouthpiece at one end, and a wider opening at the other, for placement of the mouthpiece of the inhaler. The spacer allows for greater separation (spacing) of the lips from the opening of the inhaler resulting in the inhalation of smaller particles of the medication. When using a spacer, more medication gets to the lung, with less of it landing on the mouth and tongue or bouncing out of the mouth.
Although many asthma patients in the study were using spacers, they ignored the harmonica like sound, emitted when inhaling too fast. Many people, with or without spacers, inhale much too fast. A slow, steady inhalation is important to draw the medication into the tiny airways deep inside the lungs.
I often explain to my patients the three components of success in controlling asthma:
1) Getting the right prescribed inhaler2) Using controller medication** regularly3) Having good inhaler technique**
The second and third components present the greatest challenge in asthma management.
Poor inhaler technique continues to be a daily concern for me and my staff, but we seize the opportunity to address this at each follow-up visit. Routine office visits give us an opportunity to fine-tune the asthma management plan. We want our patients to be skilled enough to train others on how to properly use an asthma inhaler, which means their inhaler technique should be flawless.
Unfortunately, you can have the best asthma medication prescribed, and perfect timing of daily doses, but if your technique has flaws, you may be getting very little of the medication to the lung. I tell patients it’s like “having a pill to cure your disease but not being able to swallow it.” Furthermore, your asthma care provider may be inclined to change your controller to a higher potency medication, thinking the current one has failed you, which can result in greater expense and increased risks of side effects.
Here are some tips on how to improve your inhaler technique:
1) Ask your doctor or nurse to critique your inhaler technique each time you have an office visit.
2) Ask for a spacer if you continue to have flaws in inhaler technique.
3) Have a relative or friend videotape your inhaler technique and try to identify your own flaws.
Asthma can’t be cured but it can be controlled by regular use of appropriate controllers, and good technique.
Board Certified Allergist and Asthma Specialist