Betty Chaffee, PharmD, is owner and sole proprietor of BetterMyMeds, a Medication Management service devoted to helping people get the maximum benefit from their medications.
The lung diseases asthma and COPD affect an estimated 50 million Americans. Both can be held in check using inhaled medications -- those with mild disease may only need a "rescue" inhaler occasionally for acute shortness of breath, while those with more advanced or severe disease may need to use one or more inhalers on a regular basis as well as a "rescue" inhaler for acute symptoms. Inhaled medications can help lungs stay as healthy as possible, allowing those with asthma and COPD to remain active and avoid hospitalizations. But whether an inhaler is used regularly or occasionally, it will only be effective if the medication is delivered completely into the lungs.
That may seem obvious, but studies show that a majority of patients who use inhaled medications don't use them correctly for a variety of reasons. This is true whether a person is using an inhaler for the first time or has been using it for years. My own experience in Medication Management supports this. I've learned that those who make mistakes while using inhalers may have been using the same type of inhaler for a number of years. They may have received good training when the medication was first prescribed, and as far as they know they are still using it the same way. But I like to compare using an inhaler to going to an exercise class. Why do we have instructors at exercise classes? Because they have to keep reminding us to support our back muscles, use correct form, hold the stretch long enough. Being told to do those things once doesn't work, we need to be reminded often in order to get the best benefit from our exercise.
Common administration mistakes with inhaled medications
And so it is for using inhaled medications. It's just easy to forget details over time. Here are some common examples of forgotten (or misunderstood) details that can cause inhaled medications to be ineffective:
"Rescue" inhalers for occasional use going out of date, or not being primed again before the next use. This can result in a person with acute symptoms not getting the expected relief, and symptoms that continue to worsen.
Not paying attention to the indicator on certain inhalers that tell if a dose has been loaded or is being delivered effectively. Many inhalers have indicators, but the're rarely the same from one device to another, so it's important to know what to look for and then be sure to take note.
Neglecting to prime a new, unused container before using it for the first time. Not all inhalers require this, but many do, and omitting this step will result in inadequate delivery of medication.
Using the incorrect medication for acute symptoms. It's not uncommon for those using more than one inhaled medication to forget which one is for regularly scheduled use and which one is for fast relief of acute symptoms.
Neglecting to rinse the mouth with water after using certain medications -- omitting this step can lead to an uncomfortable infection in the mouth or throat.
Continuing to use an inhaler after the dose counter reaches "0", when there isn't enough medication left to deliver a full dose (even though it may feel like a dose is being delivered).
All of the above and more become easy to overlook without reminders. When that happens, the inhaled medication may simply not do the job it was intended to do.
So many different types of inhalers!
To complicate matters further, there are many different kinds of inhalers available. Not just different medications, but different inhaler technologies that require different administration techniques. This is actually a good thing -- it means that researchers are working hard to find new ways to simply and effectively deliver medications into the lungs. But it also means that using inhalers can get complex. It's possible for a person who's been prescribed three different inhaled medicines to have to learn three different techniques for using them. And sometimes, the same medication may suddenly be changed to a different type of inhaler that requires a completely different technique.
Where can you get help with technique?
If you use an inhaled medication, even just on an occasional basis, it's important to have your technique evaluated regularly. With a new type of inhaler, be sure to get instructions and a demonstration before using it for the first time, and then have your technique checked in a week or two to make sure you've got it down. With long-term use of inhalers, continue to have your technique checked periodically.
Your pharmacist is in a great position to help you with this. Once a year, when you have a prescription refilled, have your pharmacist watch you use your inhaler(s) to make sure you're getting the full benefit of the medication. You may need to make an appointment with your pharmacist to ensure that he or she can set aside time when you get there, but it'll be well worth it. Inhaled medications can be costly, so let's make sure that every penny is making a difference in your health!
Instructional videos can be found on the internet for nearly every type of inhaler. Watching one with a friend or family member and then having that person evaluate your technique is another good way of getting a regular inhaler check-up if you don't have a community pharmacist who can help. You'll find links to a wide variety of how-to videos on the BetterMyMeds online resources page. Because different medications are often delivered using the same type of inhaler, the videos are listed by inhaler type rather than by medication, so for example you'll find instructions for the Symbicort Turbohaler under "turbohaler", for Breo Ellipta under "ellipta", and so forth. If you don't find a video for your inhaler, send me a comment and I'll find one to add to the list!
Get the most from your inhaled medications with help from your pharmacist!
Don't assume you're using your inhaler the right way! Use the skill and knowledge of your pharmacist to make sure your inhaler technique allows you to get the maximum benefit from your medications.
And continue to watch our posts for more information about inhaled medications and inhaler technology. If you'd like to see an article about an issue related to inhalers (or another subject), comment below or send us a suggestion. And as always, BetterMyMeds has a pharmacist available to help you get the most from all of your medications -- contact us to learn how we can help!