[This piece was written by Kathy Ristau, RRT, RPFT, AE-C with St. Peter’s Cardiopulmonary Rehabilitation and Wellness Program.]
A lot has changed in the field of respiratory medications since the invention of the metered dose inhaler (MDI) sixty years ago. While MDIs and nebulizers are still in use today, the discovery of better medications has also seen the emergence of better delivery devices.
To add to the list of respiratory devices, we have the aerolizer, flexhaler, twisthaler, handihaler, respimat, respiclick, ellipta and the discus. And along with the fancy names comes fancy lists of instructions, each one different from the next! It’s no wonder people have trouble taking their medications correctly.
The following are just two of the many instances of the “mis-taken inhaler” I have come across over the years.
The Case of the Double Pumper
One summer afternoon, an older gentleman came in for testing. As we came to the inhaler portion of the test, he chuckled and stopped me: “I can do this,” he said. “I’ve been taking inhalers for years and years.”
I handed him a placebo device so he could demonstrate his technique. He exhaled, placed the MDI with spacer in his mouth and, as he inhaled, he pumped the canister not once but twice. A DOUBLE PUMPER! I had heard they existed but had never actually met one!
After I demonstrated the correct “one puff at a time” technique and explained the reason for it, he told me no one had ever instructed him on how to use the medication. He assumed the written directions to take “two puffs, twice a day” meant two pumps on the canister at one time, both in the morning and at night!
The Occasion of the Dirty Discus
Another time, a woman who was using the Advair discus proudly told me she taught her nephew the correct way to use his device. “I told him he had to open the disk, push the lever, then slap the mouthpiece against his leg to get the ‘dirt’ out of the opening before he inhales,” she exclaimed.
When I explained the “dirt” was actually the medicine, she laughed and said, “I didn’t think it was working very well for me. I’ll take it correctly and tell my nephew he was right!”
In the first scenario, the patient was not receiving the correct dose of medication. And the patient in the second story did not get the benefit of any medication! Both illustrate the importance of asking your healthcare provider or pharmacist to review inhaler usage, especially when you receive a prescription for a new inhaler.
It is important to read the patient information leaflet that comes with your inhaler for tips on care and cleaning. If it is an inhaled steroid, always remember to rinse and spit after using the inhaler. Check the expiration date on your inhaler and be mindful of the dose counter to make sure it is not empty.
Remember, if you are taking an inhaler to maintain good lung function, you have to take the right inhaler, at the right time, with the right dose to realize the most benefit. Here’s to better breathing!
St. Peter’s Health Partners is proud to provide extensive care for patients with respiratory illness and disease through its Cardiopulmonary Rehabilitation and Wellness Program. For information, contact 518-525-5916.