Tips for Using Inhalers

1. Using inhalers correctly ensures maximum benefit of the medication. To check if you are using your inhaler correctly, demonstrate your technique in front of your doctor or asthma educator.

2. Stand up or sit up straight when you use any inhaler – this naturally expands the lungs.

3. Breathe all the way out before inhaling the medication, and hold your breath in for a count of 10 after inhaling a dose.

4. If you use an inhaler only occasionally, check its expiry date to make sure the product is still usable.

5. If you need to use two puffs, inhale one puff at a time and separate each dose by 30 seconds.

6. If you need to administer a bronchodilator and an inhaled corticosteroid (ICS) at the same time, use the bronchodilator first and the ICS 1 minute later. The bronchodilator will open the airway allowing greater penetration of the ICS.

7. Keep your inhalers in a cool, dry place. Powder inhalers are particularly susceptible to clogging.

Metered Dose Inhalers (MDIs)

The metered-dose inhaler is the most common puffer used today. Examples of MDIs include Ventolin, Flovent HFA and Atrovent.

The correct use of this inhaler is important in order to ensure that the medication, which is travelling at almost 100 km/h, does not just hit the back of the throat.

The best way to use an MDI is with a spacer device, which minimizes the drug deposition in the mouth and throat by enhancing drug delivery deep into the lungs. If you’re using an MDI without a spacer, you need to co-ordinate pressing down on the canister and inhaling the aerosolized medication so that those two actions occur at the same time.

Things to Remember

- Rinse your mouth after using your metered-dose inhaler to prevent thrush.
- The sleeve of the inhaler can be removed and cleaned with soap and water when needed, but ensure to dry it thoroughly.
- The removable cap should be replaced after each use to keep dust and dirt from clogging the spray orifice.
- You will know that your MDI is empty when the spray stream is weak and insufficient amount of medication is released, or when the counter window approaches zero, but not by shaking the inhaler.

Turbuhalers

Turbulahers are dry powder devices that deliver medication when you breathe in. Examples of turbuhalers are Symbicort and Oxeze.To load a dose, turn the base right, then left and listen for a “click”. There is very little powder that is dispensed, so you may not feel the medication enter your airway. The counter window will tell you how many doses are left; when shaking the inhaler you are hearing a desiccant, a powder that keeps the inhaler dry. Replacing the cap is important because it prevents humidity and heat from clogging the inhaler.

Asthma medications are commonly divided into two groups: the “relievers” and the “controllers”. Many people will use both –“controllers” to prevent asthma symptoms from occurring and “relievers” to treat occasional asthma symptoms. These drugs can come in a variety of forms. (See Devices section for tips on how to use the different inhalers.)

Relievers

Reliever medications are also called “rescue inhalers” or “bronchodilators”. They are used to quickly alleviate symptoms such as cough, shortness of breath, wheezing and chest tightness. They do so by relaxing the muscle that constricts the airway, allowing it to open and receive more air. They do not, however, reduce inflammation and mucus in the lungs.

Relievers play a crucial role in asthma treatment because exacerbations can occur at any time, even if you take a controller medication to prevent symptoms. Some people will also use a reliever to open the airway right before exercise.

Relievers usually work within 5 to 10 minutes and last anywhere from 4 to 12 hours. Based on their duration of action, relievers are often grouped into two categories: short-acting and long-acting.

Short-Acting Relievers

Short-acting relievers usually last about 4 to 6 hours, and therefore they are often prescribed “every 4 to 6 hours as needed”.

Examples of short-acting relievers (in Canada) are:

Ventolin HFA (Salbutamol)
Apo-Salvent CFC Free (Salbutamol)
Bricanyl (Terbutaline)
Alupent (Orciprenaline)
Atrovent (Ipratropium)

Long-Acting Relievers

Long-acting bronchodilators can only be called “relievers” if they work fast enough to be able to open the airway during an exacerbation. Their action in the body lasts about 12 hours, and they are often prescribed “twice daily as needed.”

Quick and long-acting beta agonists are:

Oxeze (Formoterol)
Foradil (Formoterol)

Serevent (Salmeterol) is a long-acting beta-agonist that is not used as a reliever because it starts to work after about 30 minutes. It can be used to keep the airway open for 12 hours, and although it can be used alone for emphysema or CODP, as an asthma treatment it is combined with a controller medication, fluticasone, in an inhaler called Advair.

Bronchodilators are well tolerated when used within their prescribed doses. They can sometimes cause shakiness or tremor, a fast heart beat, nervousness or headaches.

Next Page: Controllers