Maximizing Proper Use of Inhalers

With the rise in inhaler costs, proper use of asthma medications is becoming more crucial. According to a recent study published in JAMA and conducted by Anupam B. Jena, MD, PhD, and colleagues, FDA’s 2008 ban of chlorofluorocarbon albuterol inhalers led to large relative increases in out-of-pocket albuterol costs among privately insured patients with asthma and modest declines in their use.

Inhaler technique, manipulating the device while inhaling the medication, can be difficult and if done improperly may result in significant losses of drug intake. As a result, it can appear that the medication is not effective and additional medications may be prescribed or patients may end up in emergency situations.

The biggest mistake may be in the coordination between pushing down on the canister and inhaling simultaneously, in a slow and deep fashion. Patients may press down too quickly, or breathe in and then press down, and minimal drug gets into the lungs because the lungs are already filled up with air. This mistake deposits most of the drug dose on the tongue and the mouth, which gets swallowed and gets absorbed into the systemic circulation, but not into the lungs where it is needed. Additionally, side effects such as thrush and irritation become more likely with improper technique.

Other minor mistakes include not shaking the device between puffs or holding it upside down. Even if correct technique is demonstrated initially, some patients may develop habits going forward that lead to improper administration. That's why it is very important to learn proper technique the first time and review that technique each time an inhaler is refilled. Make sure to ask your pharmacist as often as possible to review your technique to ensure you are getting the maximum effect of your inhaled medication.

Patients struggling with metered-dose inhaler technique can get a prescription for a valved holding chamber or ask that the product be changed to a dry powder inhaler, if available. Some medications are available in multiple devices and some may be easier to use than others, but may require slightly different technique. Again, make sure you know how to use the device you have and review it regularly.