Inhalers are medical devices that deliver medication directly to the lungs, playing a significant role in managing various respiratory conditions. Proper technique ensures the medication reaches the airways effectively, providing the intended therapeutic benefit. Incorrect usage can hinder medication delivery, potentially leading to less effective symptom management.
Using a Metered-Dose Inhaler (MDI)
Using a metered-dose inhaler (MDI) correctly involves precise steps for optimal medication delivery. First, remove the cap and shake the inhaler vigorously for 10 to 15 seconds to thoroughly mix the medication and propellant. If the inhaler is new, or has not been used for a while (typically a week or more), it requires priming by releasing several test sprays into the air away from your face. Before inhalation, exhale fully to empty your lungs.
Position the inhaler with the mouthpiece facing down, either directly into your mouth or attached to a spacer device. A spacer, a tube that attaches to the MDI, is often recommended as it can significantly improve medication delivery to the lungs by holding the medicine in a reservoir, allowing for easier coordination of breath and spray. If using a spacer, place the mouthpiece between your teeth and seal your lips tightly around it. For direct inhalation, position the inhaler about one to two inches from your open mouth or close your lips around the mouthpiece.
As you begin to inhale slowly and deeply through your mouth, press down firmly on the canister to release one puff of medicine. Continue to inhale steadily for three to five seconds, drawing the medication deep into your lungs. After inhaling, remove the inhaler or spacer from your mouth and hold your breath for up to 10 seconds, if comfortable, to allow the medication particles to settle in the airways. If a second puff is needed, wait approximately 30 seconds to one minute between doses, shaking the inhaler again before repeating the process.
Using a Dry Powder Inhaler (DPI)
Dry powder inhalers (DPIs) operate differently from MDIs, requiring a distinct technique for effective use. Unlike MDIs, DPIs do not contain a propellant and generally do not need to be shaken before use. The first step involves preparing the dose, which varies by device type; some require loading a capsule, while others have a built-in mechanism to load a pre-measured dose with a click or twist. It is important to hold the DPI level or as instructed to prevent the powder from spilling out once loaded.
Before inhaling, turn your head away from the device and exhale completely to empty your lungs. This creates optimal conditions for a strong, quick inhalation, which is characteristic of DPI use. Place the mouthpiece of the DPI in your mouth and seal your lips tightly around it.
Instead of a slow inhalation, DPIs require a fast, deep, and forceful breath through the mouth to effectively draw the powdered medication into the lungs. You may not taste or feel the powder, which is normal for DPIs. After inhaling, remove the inhaler from your mouth and hold your breath for about five to 10 seconds to allow the medication to settle deeply within the airways. If additional doses are prescribed, wait about one minute before repeating the loading and inhalation steps.
Avoiding Common Usage Mistakes
Numerous common errors can reduce the effectiveness of inhaler medication delivery. One frequent mistake with MDIs is forgetting to shake the inhaler before use, which prevents the medicine and propellant from mixing properly. Failing to exhale completely before inhaling means there is less space in the lungs for the medicine to reach the small airways. Inhaling too quickly or too slowly can also cause issues; for MDIs, a slow, deep breath is ideal, while for DPIs, a quick, forceful inhalation is necessary.
Not holding your breath long enough after inhaling medication is another common error, as this reduces the time for the medication to settle in the lungs. Some individuals may not create a tight seal around the mouthpiece, allowing medication to escape. Additionally, pressing the inhaler canister too early or too late during inhalation can result in the medicine depositing in the mouth or throat rather than reaching the lungs. After using an inhaled corticosteroid, it is important to rinse your mouth with water and spit it out to prevent oral thrush, a fungal infection.
Inhaler Care and Replacement
Proper care and timely replacement of inhalers are essential for maintaining their effectiveness and hygiene. For metered-dose inhalers (MDIs), it is advisable to clean the plastic casing and mouthpiece at least once a week, as medication residue can build up and obstruct the spray. To clean an MDI, remove the metal canister, which should never get wet, and rinse the plastic components under warm running water for about 30 seconds. After rinsing, allow the plastic parts to air-dry completely, ideally overnight, before reassembling the inhaler.
Dry powder inhalers (DPIs) should never be cleaned with water, as moisture can cause the powder to clump and render the device ineffective. Instead, wipe the inside and outside of the mouthpiece with a clean, dry cloth. Proper storage is important for all inhaler types; they should be kept at room temperature, away from extreme heat, cold, direct sunlight, and moisture, such as in a humid bathroom.
Monitoring the remaining doses is crucial for timely replacement, as an inhaler may continue to spray propellant even after the medication is depleted. Many modern inhalers include a dose counter that displays the number of doses remaining, indicating when a refill is needed. For MDIs without a dose counter, keeping a manual count of actuations or noting the date of first use can help determine when the prescribed number of doses has been used. The “float test” (submerging the canister in water) is not a reliable method to determine if an MDI is empty and is not recommended.