Proper Technique is the Key to Reaping Benefits from Inhaled Medications

Environmental concerns are spurring a major shift in the kinds of inhalers available for asthma medications. Although learning proper inhaler technique has always been tricky, the introduction in recent years of many new types of inhalers has made it even more difficult to know the proper technique for a specific inhaler.

Using an inhaler incorrectly can prevent medication from reaching the target airways and raises the risk of increased asthma symptoms, attacks, and even death. But early indications suggest that new generations of inhalers coming onto the market will be more effective once people learn how to use them.

"Inhaler misuse is particularly an issue for the very young and also the elderly," says Melanie Gleason, Physician Assistant at National Jewish. "Studies have indicated that nearly 40 percent of all patients use their inhalers incorrectly. In addition, many who learn proper inhaler technique slip back into bad habits. Patients need to make sure they are using their inhalers properly."

Old style metered-dose inhalers are being phased out because they use ozone-damaging chlorofluorocarbons (CFCs) to propel medication into the airways. They are being replaced with several new kinds of inhalers, including metered-dose inhalers that use environment-friendly propellants, metered-dose inhalers triggered by inhaled breath, and breath-actuated dry-powder inhalers.

The different kinds of inhalers require different techniques, which can be a challenge to learn. If people don't use their inhalers properly, less medication reaches the airways where it is needed. As a result, asthma patients often continue to suffer asthma symptoms and attacks even though they are using their inhalers. They think the medication is not working when, in reality, the medication is just not getting to the place where it can work.

Teaching patients to use their inhalers properly has always been a problem," said Gleason. "But with so many new kinds of inhalers coming onto the market it is even more of a challenge now. Fortunately many of the new inhalers have advantages that make them more effective once people learn how to operate them."

The original CFC metered-dose inhalers launch the medication at close to 90 miles per hour, much too fast to efficiently inhale. The new HFA inhalers propel the medication at around 30 miles per hour, still too fast but better. Spacers, short tubes or inflatable bags attached to the inhaler mouthpiece, can help slow the delivery of the medication and make it easier to properly inhale.

The breath-actuated inhalers help solve another problem, the difficulty of timing the intake of breath with the release of the medication. The proper timing is guaranteed because inhalation actually triggers the release of the medication.

The dry-powder inhalers rely solely on the force of breath to draw the medication into the lungs, which means that the medication arrives at the right time and right speed. In addition, some studies have indicated that patients like using these inhalers more than the metered-dose inhalers. However, the dry-powder inhalers can be difficult for young children to operate because they can't inhale powerfully enough to draw the medications down into their lungs.

The National Jewish Web site has specific instructions for properly using several of the most common inhalers. Go to "Treatments and Medications."

"Probably the most important step asthma patients can take to assure that they are using their inhalers properly is to review their technique with a doctor or other healthcare professional," said Gleason. "A provider who is familiar with proper usage of the various devices can spot problems with your technique and offer suggestions to get you on the right track."