What are the proper instructions for using an inhaler to manage asthma symptoms?

Proper Instructions for Using an Inhaler to Manage Asthma

The proper use of an inhaler for asthma management requires following a specific step-by-step technique to ensure optimal medication delivery to the lungs, which is essential for controlling symptoms and preventing exacerbations.

Types of Inhalers

There are several types of inhalers commonly used for asthma management:

1. Metered-Dose Inhalers (MDIs)

   • Most common type
   • Requires coordination between actuation and inhalation
   • Should be used with a spacer/valved holding chamber (VHC) for optimal delivery

2. Dry Powder Inhalers (DPIs)

   • Breath-activated
   • Requires adequate inspiratory flow
   • No spacer needed

3. Soft Mist Inhalers

   • Slower spray delivery
   • Less coordination required

Step-by-Step Instructions for MDI Use

Preparation:

1. Remove the cap and hold inhaler upright
2. Shake the inhaler vigorously for 5 seconds
3. If using for the first time or not used recently, prime by releasing 1-2 test sprays into the air (away from face)

Using with a Spacer (Recommended Method):

1. Attach the inhaler to the spacer
2. Exhale completely away from the spacer
3. Place mouthpiece between teeth and seal lips around it
4. Press down on the inhaler canister once to release one dose into the spacer
5. Breathe in slowly and deeply through the mouth
6. Hold breath for about 10 seconds or as long as comfortable
7. Remove spacer from mouth and exhale slowly
8. Wait approximately 30-60 seconds before repeating for additional doses

Using without a Spacer:

1. Exhale completely away from the inhaler
2. Position the mouthpiece 1-2 inches from open mouth (or place in mouth with lips sealed around it)
3. Begin to breathe in slowly and deeply through the mouth, then press down on the inhaler canister
4. Continue to breathe in slowly and deeply
5. Hold breath for about 10 seconds or as long as comfortable
6. Remove inhaler from mouth and exhale slowly
7. Wait approximately 30-60 seconds before repeating for additional doses

Step-by-Step Instructions for DPI Use (e.g., Wixela Inhub)

1. Hold the inhaler in one hand and lower the mouthpiece cover with the other hand 1
2. Push the lever down completely (until you hear a click) 1
3. Keep the inhaler in vertical position and do not move the lever once pushed down 1
4. Exhale completely away from the inhaler 1
5. Place mouthpiece to lips and breathe in quickly and deeply 1
6. Remove inhaler from mouth and hold breath for about 10 seconds 1
7. Exhale slowly 1
8. Close the inhaler by pushing the mouthpiece cover up 1

After Using Any Inhaler

1. Rinse mouth with water and spit it out (especially after using corticosteroid inhalers) to prevent oral thrush 1
2. Replace the cap on the inhaler to keep the mouthpiece clean
3. Keep track of doses used (many inhalers have dose counters)

Common Mistakes to Avoid

• Not shaking the MDI before use
• Inhaling too rapidly with MDIs (should be slow and deep)
• Inhaling too slowly with DPIs (should be quick and forceful)
• Not holding breath after inhalation
• Poor coordination between actuation and inhalation with MDIs
• Not using a spacer with MDIs when recommended
• Not rinsing mouth after using corticosteroid inhalers
• Not keeping track of remaining doses

Special Considerations

• For children, a metered-dose inhaler with spacer is preferred 2
• Face masks may be needed for very young children using spacers 3
• For DPIs, patients must be able to generate adequate inspiratory flow 2
• Regular checking of inhaler technique by healthcare providers is essential 2

Monitoring and Follow-up

• Peak flow monitoring can help assess asthma control
• Follow your written asthma action plan
• See your healthcare provider regularly to review inhaler technique
• Replace inhalers before they're empty (keep track using the dose counter)

Proper inhaler technique is crucial for effective asthma management. If symptoms persist despite using your inhaler as directed, consult your healthcare provider for assessment and possible adjustment of your treatment plan.