First draft. Informed comment is invited.

USING INHALERS

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TYPES OF INHALER

The two main types of inhaler follow the form of the medication. Which type you use is primarily a matter of personal preference, guided by your doctor, provided you have the most effective type for you.

They are

• Dry Powder Inhalers for drugs in powder form;
• Metered Dose Inhalers for drugs in liquid form, deliverd by aerosol spray.

  Nebulisers are used for for drugs in liquid form, where a more substantial dose is required. They are usually used under supervision in hospitals, or at home by experienced users.

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Dry Powder Inhalers

In this type of inhaler, the drug is delivered in a dry powder form. The patient sucks in air through the inhaler. The air flow picks up the drug, and this is breathed in to the lungs.

The main steps in using this type of inhaler are :-

• 1. Select a capsule of the required medication ;
• 2. Insert the capsule in the hole in the inhaler;
  ( Note Some inhalers are pre-loaded with medication, and the next dose is selected by turning a dial;)
• 3. Separate the halves of the inhaler if required to remove the previous capsule, and re-assemble the inhaler;
• 4. Twist the two halves of the inhaler in opposite directions to break open the new medication capsule;
• 5. Breathe out as much as you can;
• 6. Put the mouth-piece of the inhaler into your mouth;
• 7. Look up, tilting your head back, so that the powder will go into your lungs instead of hitting the back of your throat;
• 8. Breathe in as fast and as deeply as you can;
• 9. Hold your breath for a few seconds, as long as you can;
• 10. Breathe normally, and repeat the dose if required.

Comment

The main advantage of this type of inhaler is that it does not require you to co-ordinate breathing in with operating an aerosol spray.

Point 7 applies to all inhalers. Normally the back of the throat has a right angle bend from the mouth to the windpipe. This is straightened out by looking up. However, be careful that the powder does not fall into the mouth before inhaling.

Point 9 also applies to aerosol inhalers. If you breathe out too soon, you will also breathe out some of the medication still suspended in the air. By holding your breath, this has time to settle on the intended places.

Inhaler Maintenance

The dry powder inhaler can last for quite a long time if properly looked after.

Almost the only maintenance is cleaning.

After a time, a residue of powder will build up. This can be quite abrasive, and scratch the surfaces of the halves of the inhaler which rotate. (The powder is not that hard, but the plastic is soft.)

This is easily removed by normal washing up, and rinsing in hot or cold fresh water. (Do not use boiling water unless the makers instructions suggest this.)

Make sure that the inhaler is totally dry before use.

The mouth-piece will also become fouled with deposits from the user's mouth. Washing is also the answer to this, but a longer soak may be needed.

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Metered Dose Inhalers

In this type of inhaler, a liquid medication is propelled by an aerosol spray. The user has to breathe in at the same time as operating the aerosol. Otherwise use is much the same as for dry powder inhalers.

The main steps in using this type of inhaler are :-

• 1. Select the required inhaler;
• 2. Check that it still contains medication (the dose meter);
• 3. Fit a spacer, if you have one available;
• 4. ;
• 5. Breathe out as much as you can;
• 6. Put the mouth-piece of the inhaler or spacer into your mouth;
• 7. Look up, tilting your head back, so that the spray will go into your lungs instead of hitting the back of your throat;
• 8. As you press the aerosol sprayer, breathe in as fast and as deeply as you can;
• 9. Hold your breath for a few seconds, as long as you can;
• 10. Breathe normally, and repeat the dose if required.

This type of inhaler is disposable when the supplied medication runs out, and so does not normally require any maintenance.
Spacers, however, will need to be washed from time to time. As with dry powder inhalers, normal washing up and a fresh water rinse is suitable.

Aerosol inhalers are called "metered dose inhalers" because they are designed to deliver the same amount of spray every time they are used. They contain a mechanism to give the same spray whether the button is pressed briefly or held down.

They also contain a counter which warns when the medication is about to run out.

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Comment on Inhaler Efficiency

Most inhaler methods get only 10% to 30% of the medication to where it is wanted. Of the rest, most lands in the mouth and throat, where it can be a nuisance.

The purpose of spacers (only with aerosol inhalers) is to improve the amount of medication which reaches the lungs. They work by improving the mix of the spray and the inhaled air, and by slowing down the particles of spray. Instead of being fired at the back of the throat, the spray follows the main air flow to the lungs.

Proper use of the inhaler is very important. If you are not taking it properly, you might as well not take any medication.

If you want advice to make sure you are using the inhaler properly, make an appointment to see the asthma nurse at your doctor's.

For more information, see
What is Asthma?
Types of Asthma
COPD

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Please contact us to share your experience or any information which may help others.

e-mail to
enquiries@asthma-support.org.uk

July 2000