Cleveland Clinic respiratory therapist Mary Kay Bossard demonstrates the proper technique for using inhalers, and explains the importance of using medications to manage COPD and asthma.
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There's different inhalers. This is what we call a metered dose inhaler or an MDI. It's the most common. It's been around the longest. It is just a puffer that when they spray it, a certain amount of medication is going to come out no matter how long they hold it down. The correct way of doing this is putting it directly in the mouth, lip sealed tight around it, and as they begin to breathe in, they press it, and they breathe all the way in slowly, and hold their breath.
That's a coordination issue that many patients have problems with. So we like to give them what we call chambers or spacers. There's many out there. This is a one-way valved chamber. It's the most effective to be used, and the inhaler simply fits in the back of it. So, when you're spraying, instead of it spraying directly into the mouth and the patient having to coordinate that spray and breath in, they spray first into the chamber, and then take a very slow breath in. This also has a little whistle on it that if they breathe in too quickly, it means they're going too fast, so it controls their technique. It gets more medication in the lungs, about 10% more, which is effectively doubling what they're getting in their lungs. They don't have to coordinate the spray and the breath in, so this is probably the best way to use a metered dose inhaler. We insist they use it always with an inhaled corticosteroid, which is a controller medication.
Now, besides the metered dose inhalers, we have different dry powder inhalers, and these are two examples of dry powder inhalers. A dry powder inhaler is simply a device that holds a medication. There's no propellant, so the difference here is they're not spraying anything into their mouth. They're going to put this in their mouth after they've gotten it ready, and they're going to pull the medication out. One device, the Diskus that I'm holding right here has very little resistance in it, and a wide range of flow rate techniques will get it well in the lungs. This device, which is called a Twisthaler, has more resistance in it which means the patient has to pull in stronger to get the medication out. So that's why it's so important to teach the proper technique.
The way we do that here is we use this little inspiratory meter, and it actually has the different devices that you can dial in the device, and what happens is it mimics the resistance the patient will get through the device you're teaching. There's also flow rate ranges where the medication gets in the lung best, and so you train them to get the cursor that's in here, there's a little red cursor in here, you train them to breathe in so this cursor ends up within the appropriate flow range.
If you teach them the two techniques, chances are they're going to go home and get confused, and so when they come back the next time you find they've switched the technique. The slow technique that you need for puffer, they're doing on the dry powder, and the faster technique on the dry powder, they're doing on the puffer. So, that's why it's so important to explain to them differences between the types of inhalers, why they have to do things the way they have to do them, and review it whenever you see them to make sure they're doing it correctly.
Bottom line is asthma's a chronic disease, but it can be controlled. If you recognize your symptoms, you avoid your triggers, you work with your practitioner, take your medications the way they've been ordered, then you will be able to lead a normal life. You should be able to do anything you want to do, and that is the goal of asthma therapy.
