If you’re like most of the 15 million Americans with asthma, you use a press-and-breathe inhaler. And, if you’re like most, you’re probably not using your inhaler to full advantage. Consequently, you may not be receiving complete benefit of your asthma medication.
The National Institutes of Health’s (NIH) updated Guidelines for the Diagnosis and Management of Asthma offer three suggestions for correct inhaler use to ensure that you receive the most from your medications: 1) retraining in the correct use of the inhaler by a professional at every visit; 2) attaching a holding chamber, or spacer, to the inhaler; 3) using a breath-actuated inhaler.
Inhalers Work Better
Unlike pills or needles, inhalers direct your asthma medication into your lungs, where it’s needed most. Inhaled medications use smaller doses than other forms, and side effects are generally reduced because the medication does not travel through your system.
For full benefit, sufficient medication must be inhaled deep into the lungs. Some patients try to ensure good results by taking more doses than prescribed. A recent study demonstrated that patients using press-and-breathe inhalers actually used 47 more puffs per month than they reported.
Inhaler overuse can mask symptoms that might need reevaluation. Overuse can also cause side effects, even death. And it certainly costs you more money.
Inhalers Require Good Hand and Breath Coordination
Press-and-breathe inhalers require mastery of several coordinated maneuvers. First, you exhale. Then, with lips closed firmly around the mouthpiece, inhale through the mouth and, at the right moment, press the canister top to trigger medication release. Continue a slow, deep inhalation, then hold your breath for up to 10 seconds before exhaling. If each of these steps is performed correctly, a premeasured dose is deeply inhaled into the lungs.
Using a press-and-breathe inhaler correctly every time is difficult even for people who have used one for years. One reason is that it’s hard to time your inhalation while a jet of medication shoots into your mouth at 70 miles an hour.
Studies of patients using conventional inhalers reveal that nine out of ten have poor technique, and so may not receive full medication benefit. Children and seniors have particular trouble mastering the correct technique, but patients across all age groups and experience levels demonstrate problems.
Other difficulties include:
- Poor synchronization in pressing the inhaler canister and breathing in the medication.
- Not holding a breath long enough after inhaling.
- Inhaling too quickly.
- Inhaling through the nose instead of the mouth.
- Breathing out the medication before holding the breath.
The next time you visit your doctor for an asthma evaluation, ask to demonstrate how you use the inhaler. The doctor can then determine which of the following guidelines is right for you.
Retraining patients on inhaler technique is the most common solution employed by health care professionals. Retraining teaches correct use of the inhaler every time you visit. You may watch a video that demonstrates good technique, or practice using an inhaler containing no medication.
For some patients, retraining ensures consistently correct technique. But studies reveal that even after retraining, many patients revert to old habits. Their technique—and their asthma—suffers.
Solution 2—A Spacer
A spacer is a special tube attached to the inhaler’s mouthpiece. It traps the medication after release, allowing time to inhale the medicine in one slow, deep breath.
Studies show that patients who use spacers inhale about as much medication as those who correctly use their inhaler without a spacer. Those who have problems coordinating pressing and breathing receive more medication with an attached spacer.
Spacers cost about $20, and are made in different shapes and sizes. Some are plastic; others are metal. Recent studies demonstrate that certain inhaled medications are better delivered with specific types of spacers. Your doctor can prescribe the best spacer for you.
Solution 3—The Breath-Actuated Inhaler
The national asthma guidelines now recommend the breath-actuated inhaler as an alternative to the press-and-breathe type. Available in this country for about five years, breath-actuated inhalers are popular among asthma specialists and family doctors because they automatically release a medication puff as you inhale on the mouthpiece. No coordination of pressing and breathing is required, and no need for a spacer.
A breath-actuated inhaler releases a gentler puff of medication than the press-and-breathe style, and most patients find it easier to inhale. Some patients, however, incorrectly equate a spray’s force with the medication’s ability to work, and believe that the breath-actuated inhaler lacks sufficient power to get medication into their lungs. The fact is, getting medication into your lungs does not depend on the force of the spray. The medication—whether a puff or a powerful spray—must be inhaled. The breath-actuated inhaler automatically releases the right dose of medication during inhalation, so consistent treatment is maintained with less medication.
In the clinical study noted above, reported monthly use of the breath-actuated inhaler versus actual monthly use differed by an average of five medication puffs per patient. This suggests that a breath-actuated inhaler can more accurately monitor asthma medication use and better alert your health care providers if treatment changes are required.
Currently, the only breath-actuated aerosol inhaler available in the United States is Maxair Autohaler (pirbuterol acetate inhalation aerosol). Its active ingredient, pirbuterol acetate, belongs to the same group of quick-relief medications as the drug, albuterol, found in Ventolin and Proventil HFA press-and-breathe inhalers. Quick-relief medications are best for relieving sudden, severe asthma episodes, but everyday use is not recommended. Side effects of pirbuterol are typical of quick relief medications.
Pharmaceutical companies are developing breath-actuated inhalers containing other medications that should be available in the future.
Breath-actuated inhalers and spacers, and consistent and correct inhaler technique, provide practical solutions for people with asthma—solutions that make medications more effective and help you breathe easier.