Chronic Obstructive Pulmonary Disease (COPD) is a progressive lung disease that causes airflow limitation, making breathing difficult. The standard of care involves inhaled medications, which deliver therapeutic agents directly to the airways to reduce inflammation and open the bronchial tubes. Inhaler devices are highly effective because they allow smaller drug doses to act quickly where they are needed most, minimizing systemic side effects. However, the effectiveness of this treatment relies entirely on the user’s correct technique, as many people use their inhalers incorrectly, compromising the amount of medicine that reaches the lungs. Understanding the mechanics of each inhaler type and practicing the proper steps is necessary to ensure optimal disease control and symptom relief.
Types of Inhalers Used for COPD Treatment
COPD medication is delivered through distinct types of handheld devices, each requiring a slightly different inhalation technique. The most common is the Metered-Dose Inhaler (MDI), which uses a chemical propellant to release a measured dose as a fine, pressurized aerosol spray. The user must coordinate pressing the canister with their breath to inhale the medicine effectively.
Dry Powder Inhalers (DPIs) deliver the drug as a micro-fine powder without using propellant. These devices are breath-activated, meaning the user’s forceful inhalation pulls the powder into the lungs. The third type is the Soft Mist Inhaler (SMI), which uses a mechanical spring to create a slow-moving, fine mist. SMIs require less coordination and may achieve higher lung deposition than MDIs or DPIs. The choice of device often depends on an individual’s ability to perform the required maneuver.
Step-by-Step Guide for Metered-Dose Inhalers
Using an MDI requires careful timing between device activation and a slow, steady breath to ensure the aerosolized medication reaches the lower airways. First, shake the MDI vigorously about 10 to 15 times to ensure the medicine is properly mixed within the propellant. If you are not using a spacer, breathe out gently and completely to empty your lungs away from the device.
Place the mouthpiece between your teeth and seal your lips tightly around it, then press down firmly on the canister to release a puff of medicine. The most challenging step is coordinating this puff with a slow, deep inhalation that should last for three to five seconds. After inhaling, remove the device from your mouth and hold your breath for up to 10 seconds to allow the medicine to settle deep into the lungs.
A spacer, which is a tube-like device that attaches to the MDI, can significantly improve the efficacy of this inhaler type. The spacer holds the released medication, eliminating the need for precise hand-breath coordination and reducing drug deposition in the mouth and throat. To use a spacer, attach the MDI, shake the assembly, and press the canister to spray one puff into the chamber. Immediately begin breathing in slowly and deeply through the spacer’s mouthpiece, holding your breath for 5 to 10 seconds afterwards.
Step-by-Step Guide for Dry Powder Inhalers
Dry Powder Inhalers (DPIs) require a fast and forceful inhalation to draw the medication into the lungs. Prepare the dose by following the specific instructions for your device, which might involve loading a capsule, clicking a lever, or twisting the base. DPIs should never be shaken or used with a spacer.
Before placing the device in your mouth, breathe out fully and gently away from the inhaler to empty your lungs. This step ensures you can take the largest possible breath to activate the device and inhale the powder. Place the mouthpiece in your mouth and seal your lips tightly around it to prevent air leakage.
Inhale very quickly and deeply through your mouth to pull the powdered medicine out of the device. The inhalation must be sharp and forceful for the powder to be successfully delivered to the airways. Remove the inhaler from your mouth and hold your breath for about 10 seconds to maximize drug settling in the lungs.
Troubleshooting and Device Maintenance
Improper technique reduces the amount of medication reaching the lungs, leading to poor COPD control and increased risk of flare-ups. A common error with MDIs is not breathing in slowly enough, causing the medication to impact the back of the throat. For DPIs, the opposite error—not breathing in quickly and forcefully enough—results in insufficient drug release.
Always check the dose counter or indicator on your device to know when the medicine is running low, ensuring you refill the prescription before it is empty. Maintenance procedures differ substantially between the devices: MDIs and their spacers can be cleaned by rinsing the plastic parts with warm water and allowing them to air dry. Dry Powder Inhalers must never be washed or exposed to water, as moisture causes the powder inside to clump and clog the device.
If your inhaler contains an inhaled corticosteroid, rinse your mouth thoroughly with water and spit it out immediately after use. This action prevents the medicine from lingering in the mouth and throat, helping avoid potential side effects like oral thrush or voice changes. Regularly reviewing your technique with a healthcare professional ensures you receive the full therapeutic benefit of your COPD medication.