Chronic Obstructive Pulmonary Disease (COPD) is a progressive lung condition characterized by persistent airflow limitation, which includes conditions like emphysema and chronic bronchitis. The primary method for managing COPD is the direct delivery of medication to the airways using an inhaler device. Correct inhaler technique directly influences how much medicine reaches the lungs, ensuring maximum therapeutic benefit and symptom control. Improper technique reduces the medication’s effectiveness, potentially leading to increased symptoms and more frequent exacerbations.
Understanding the Different Inhaler Types
Inhalers are categorized by their mechanism of drug delivery, which dictates the technique needed for effective use. The two most common types used for COPD are Metered-Dose Inhalers (MDIs) and Dry Powder Inhalers (DPIs). MDIs contain medicine in a pressurized canister, which releases a fine, propellant-driven mist when the canister is pressed. DPIs, by contrast, contain the medication in a fine powder form that requires the user’s quick and forceful inhalation to activate and draw the dose into the lungs. A third, less common type is the Soft Mist Inhaler (SMI), which delivers a slow-moving, fine mist without the use of a harsh propellant.
Step-by-Step Guide for Metered-Dose Inhalers (MDI)
Using a Metered-Dose Inhaler effectively requires precise coordination between activating the device and inhaling the medication. If the device is new or unused for a few days, it must first be “primed” by spraying one or two test puffs into the air. The canister must be shaken vigorously before each use to mix the medicine and propellant evenly. Next, sit or stand up straight and breathe out completely, emptying the lungs away from the device.
Place the mouthpiece in the mouth, and as you begin to inhale slowly and deeply, press down firmly on the canister to release the medication. This simultaneous action is often the most challenging part of MDI use. Continue the inhalation slowly for about three to five seconds, drawing the aerosolized medicine deeply into the lungs. After removing the inhaler, hold the breath for up to 10 seconds to allow the medication particles to settle. If a second puff is required, wait one full minute before repeating the entire process, starting with shaking the inhaler again.
For many users, especially those with coordination difficulties, a spacer device is highly recommended to bridge the gap between the inhaler and the mouth. A spacer is a hollow chamber that holds the released medicine mist, eliminating the need for perfect timing. Using a spacer increases the amount of medicine reaching the lungs while reducing deposition in the mouth and throat. When using a spacer, press the canister once, then breathe in slowly and deeply from the mouthpiece, holding the breath for 10 seconds.
Step-by-Step Guide for Dry Powder Inhalers (DPI)
The technique for using a Dry Powder Inhaler is fundamentally different from an MDI, relying on the strength of the user’s breath rather than a propellant. First, prepare the dose by twisting a mechanism, sliding a lever, or loading a capsule, depending on the specific DPI brand. Once the dose is loaded, exhale fully away from the device, ensuring the lungs are empty before inhalation.
Seal the DPI mouthpiece tightly with the lips, and inhale very quickly and deeply to draw the powdered medicine into the lungs. This fast, forceful breath is necessary to overcome the internal resistance of the device and break up the powder into breathable particles. This requirement for a fast, deep breath contrasts with the slow inhalation needed for an MDI.
Never exhale directly into the DPI, as moisture can cause the fine powder to clump, rendering the dose ineffective. After the quick and deep inhalation, remove the inhaler and hold the breath for a full 10 seconds to maximize drug deposition. If the device contains a corticosteroid, rinse the mouth with water and spit it out immediately after use to prevent oral thrush.
Cleaning, Storage, and Dose Counting
Proper maintenance is necessary to ensure inhalers deliver the intended dose accurately. Metered-Dose Inhalers should be cleaned at least once a week by removing the metal canister and rinsing only the plastic casing and mouthpiece with warm water. The plastic parts must be allowed to air-dry completely before the canister is reinserted. The metal canister itself must never be put in water.
Dry Powder Inhalers should not be exposed to water due to the powder’s sensitivity to moisture, which can cause clumping and block the device. Cleaning a DPI involves wiping the mouthpiece with a dry cloth or tissue to remove residue. All inhalers should be stored in a cool, dry place at room temperature, away from direct sunlight or excessive heat.
It is important to track the remaining doses in the inhaler to avoid running out of medication unexpectedly. Many modern devices feature a dose counter that displays the number of doses remaining, and the device should be replaced when the counter reaches zero. For older MDIs without a counter, users must manually track the number of puffs used. This is crucial because the propellant may continue to spray even after the medicine is depleted. The canister must be discarded after the prescribed number of doses, even if propellant remains inside.