An inhaler is a device that delivers aerosolized medication directly into the lungs, serving a significant purpose in managing respiratory conditions such as asthma and Chronic Obstructive Pulmonary Disease (COPD). When an inhaler fails to provide the expected relief, it represents a serious health concern, potentially indicating an issue with the device, the user’s method, or a change in the underlying medical condition. Addressing the problem requires a methodical approach that first considers the physical state of the equipment before moving to technique and finally, medical assessment.
Checking the Device and Medication Supply
The first step in troubleshooting a non-responsive inhaler involves a physical inspection of the device and its medication status. Many modern inhalers, including Metered Dose Inhalers (MDIs) and Dry Powder Inhalers (DPIs), feature a dose counter that displays the number of remaining doses. If this counter reads zero or is in the red warning area, the inhaler is empty and will not deliver medication. Older MDIs may lack a counter, making manual tracking of doses necessary.
Another common issue is a clogged mouthpiece, which happens when medication builds up and obstructs the pathway. For MDIs, the medication canister must be properly seated and aligned within the plastic actuator to ensure the correct dose is released upon pressing. The medication also has an expiration date; using an expired inhaler may result in a lack of efficacy. DPIs, which contain powdered medication, are sensitive to moisture and should not be stored in damp environments like a bathroom, as the powder can clump and fail to disperse effectively.
Errors in Inhaler Technique
Even with a full and functional inhaler, poor administration technique can prevent the medication from reaching the small airways where it is needed. A common error with the pressurized MDI is insufficient shaking before use, which is necessary to properly mix the medication and the propellant. Users of MDIs often fail to coordinate the action of pressing the canister with the start of a slow, deep breath, resulting in the medication hitting the back of the throat instead of traveling to the lungs.
Inhalation speed differs significantly between device types, and confusing the techniques is a frequent mistake. MDIs require a slow, steady inhalation lasting approximately three to five seconds. In contrast, most DPIs demand a quick, deep, and forceful breath to ensure the powder is successfully aerosolized. After inhaling, hold the breath for up to ten seconds, or as long as comfortable, allowing the particles to settle within the lungs. Inhalation must also be done through the mouth, not the nose, to direct the medication correctly.
For MDIs, using a spacer device helps eliminate the need for hand-breath coordination and increases the amount of medication that reaches the lungs. If a spacer is used, a tight seal around the mouthpiece is necessary. Breathing in too quickly can cause a whistling sound, indicating the user needs to slow down their inhalation. Users must also remember to exhale completely away from the inhaler before taking a dose to empty the lungs and prepare for a deep inhalation.
When the Medication Isn’t Providing Relief
If the inhaler is functioning correctly and the technique is flawless, the lack of relief points to a worsening of the underlying respiratory condition. This may occur if the disease has progressed, leading to increased airway inflammation and tightening that the usual dose of medication cannot overcome. It is important to recognize the difference between quick-relief (rescue) inhalers and long-term controller medications, which reduce chronic inflammation over time. Controller medications must be taken daily, even when symptoms are absent, because their protective effect builds up gradually.
Over-reliance on a rescue inhaler, such as using it more frequently than prescribed, suggests that the condition is poorly controlled and requires a comprehensive review of the treatment plan. While rare, tolerance or resistance to the medication’s effect can develop with excessive use, potentially reducing its effectiveness during an acute episode. When a rescue inhaler fails to provide relief, it signals a severe exacerbation. Signs of a medical emergency include difficulty speaking in full sentences, very rapid breathing, a straining of chest muscles, and a bluish tint to the lips or nails.
If the rescue medication does not improve symptoms, or if the user experiences confusion or lightheadedness, immediate medical help must be sought. Calling emergency services is necessary if breathing difficulties persist or worsen after using the quick-relief inhaler. Patients should refer to their personalized Asthma Action Plan, developed with their healthcare provider, to guide these urgent decisions.
Maintaining Inhaler Efficacy and Next Steps
Preventative maintenance ensures an inhaler remains effective. For MDIs, routine cleaning of the plastic actuator is necessary to prevent the buildup of medication that can cause clogs. This involves removing the metal canister and rinsing the plastic components under warm water at least once a week, allowing them to air-dry completely. Dry Powder Inhalers should never be washed with water due to the sensitivity of the powder, but the mouthpiece should be wiped regularly with a clean, dry cloth.
Spacers and holding chambers, which are used with MDIs, also require weekly cleaning to prevent medication residue and static electricity from interfering with drug delivery. After an episode where the inhaler was ineffective, schedule an urgent appointment with a healthcare provider. This consultation allows for a review of the current prescription, including possible dose adjustments or switching to a different medication or device type.
Regular follow-up appointments are the ideal time to have a pharmacist or respiratory therapist observe and verify the user’s inhalation technique. Ensuring proper use is an ongoing process; professional confirmation can correct subtle errors that affect medication delivery. Additionally, all inhaler users should check the expiration date monthly and replace the device before it expires, ensuring the medication is potent when needed most.