Learning to inhale

  About how to inhale

Two months ago, I posted an article called, “Timely Medications,” (Aug 27) that talked about the need to take your medications consistently and tips to help achieve that. Here, finally, is the sequel to that article. Like most of you, I was sidetracked in September and I’m now ready to pick up where I left off.

So…

Taking medications on time is certainly important. HOW you take your medications is equally important. After all, what is the point of diligently following your doctor’s instructions on when and how much medication to take, when you are taking them incorrectly? Pills and liquids are fairly straightforward. You take your pill (or pills) X number of times a day. Your basic concerns are: with or without food; and chew versus swallow. Not too complicated, even for young children.

Inhalers, on the other hand, are a different story. Inhaled improperly, and you may be missing out on all the benefits the medicine can give you. At the worst, you may not get any help or may be setting yourself up for some unforeseen side effects. Therefore, learning to inhale is critical for getting the most out of your meds.

Besides inhaling correctly, you need to keep in mind that not all inhalers are created equally. Thanks to medical and technological advances, there are several types of inhalers that make delivery easy and convenient. The inhalation techniques vary slightly from one form to the other, so I will address each separately, although some general principals apply to each kind.

First, order is important. If you are using more than one inhaler, take the bronchodilator before your maintenance medication. (See “Understanding your Medications” 23 Aug 2000) Most bronchodilators are fast-acting so they will open the airways to allow maximum absorption of your long term, anti-inflammatory (like Flovent™ or Intal™). The key is to give the bronchodilator a few minutes to work before taking the next inhaler. You can apply this same order if you are using a nebulizer, although your doctor may instruct you to mix the two medications and take them at the same time. Check with your physician before doing this.

For nebulizers, the technique is the same regardless of the medication being delivered. Take deep, regular breaths. Sucking the vapor in quickly won’t speed up the process and you may prevent medication from getting completely into the lungs. Try, also, to hold your breath for a few seconds to keep the medication in your lungs a bit longer. This helps with absorption. Of course, if you are having an asthma attack and are using a bronchodilator in your nebulizer, breathing deeply and holding your breath is going to be difficult if not impossible. That’s okay. As the medicine starts to work, you will gradually be able to take longer, deeper breaths in about five to 10 minutes. If not, seek medical attention!

Rescue inhalers, albuterol, Ventolin®, are probably the most commonly used and most people take two puffs per dose. Remember to shake the canister and to inhale as quickly and deeply as possible immediately after squeezing the inhaler. If your timing is off, you may end up swallowing more medication and it won’t do any good in your stomach. This can be a difficult technique to master, especially for young children. Many times a spacer is used to help deliver the medication properly. A spacer is a tube that fits onto the inhaler. You spray the medication into the spacer, then inhaler slowly from the spacer. You will need a prescription for a spacer, so speak with your physician about which type of spacer, if any, is appropriate for you.

Also, it is important to wait at least one minute between puffs and to hold each one for about 15 seconds.

Flovent™, one of many long acting anti-inflammatory drugs, is another common inhaler. Chances are, you WILL be using a spacer with this one, particularly kids. The only difference with Flovent™ and other inhaled steroids is that it is important to rinse your mouth after each complete dose (not after each puff if you take two puffs.) Failing to rinse could result in a mouth rash commonly known as thrush, but is really a Candida yeast infection. When this happens, the tongue is coated in a thick white substance and the center may be red and irritated. Though it is easily treated with antibiotics, it is even easier to avoid by rinsing.

A few years ago a new type of inhaler hit the market, the disk. In this case, the medicine inside is more like a powder than a liquid mist. For disks, it is important NOT to shake the container and to keep it level. Unlike the traditional inhalers, you don’t need to time the squeeze and the quick inhale. Instead, when you cock the disk, it loads a small chamber with the medication. With your mouth all the way on the disk (like a straw), you then draw in completely and relatively slowly. These inhalers do not rely on propellants. The medication is delivered by your lung power.

The information in this article is just a guideline. If you are unsure about how to use any of your inhalers, check with your doctor’s office. The nurses and respiratory therapists are very knowledgeable and are there to help.

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