I was prescribed my first albuterol inhaler when I was in high school for mild asthma. I attached a shoestring to the plastic dispenser and wore it around my neck underneath my football pads during practice. It never seemed to provide my lungs any relief from wheezing and I couldn’t understand why. Eventually I tossed it in a drawer and gave up on treating my asthma. It wasn’t until I went to pharmacy school in the ‘90s that I found out just why it wasn’t working. I had no idea how to properly use the thing, and nobody had ever shown me how.

Inhalers can provide nearly instant relief to asthma sufferers. Some inhalers are designed for maintenance and must be used daily to control the disease. There are several types of inhalers used to achieve different goals:

Albuterol inhalers (Provental, Ventolin, ProAir etc.) are designed to bring relief to asthma symptoms immediately. When used properly, the drug is delivered directly to the lung tissue where it dilates the airway by relaxing the surrounding muscles. These are referred to as short-acting bronchodilators and they are designed to bring quick relief to symptoms like shortness of breath, wheezing, chesttightness, and coughing. Sometimes they are used before exercise to help prevent exercise-induced asthma.

Drugs that work over a longer period of time are maintenance inhalers. Drugs like Atrovent, Advair, and Flovent are to be taken on a daily basis to help keep asthma symptoms from flaring up. Patients usually have to take these all the time unless their asthma is triggered by allergens that are present only certain times of the year.

Regardless of the intent, if inhalers aren’t used properly then the patient will not get relief from symptoms.

Use of metered dose inhalers:

1. Remove the cap from the inhaler and set aside. Shake the inhaler.

2. Breathe out all the way and insert the mouthpiece into your mouth. (Some recommend holding the inhaler 2 inches away from the moutheither method works).

3. Begin breathing in slowly and deeply. While breathing in, press the canister to release the medication.

4. Continue breathing in then hold your breath for a 10-count if you can.

5. Wait one minute for additional puffs

These steps can be difficult to do correctly if you are not used to them. They take a little coordination and practice and sometimes it is difficult for children and elderly people. A spacer is a device that can help deliver the medication in these circumstances. A spacer is a tube that is placed on the end of the inhaler to hold the medication particles momentarily while you breathe in. This allows more time for the user to inhale and breath in the medication while the particles are suspended in the spacer. Without a spacer, timing is much more of a concern. Spacers may be purchased at the pharmacy, or an empty toilet paper or paper towel roll can be used.

Use of metered dose inhaler with spacer:

1. Shake the inhaler and fit the spacer on the end of the mouthpiece.

2. Place your mouth over the end of the spacer.

3. Begin breathing in slowly and press the canister to release the medication. Some spacers have a flow signal whistle to alert you if you inhale too quickly.

4. Hold your breath for a 10-count if possible.

5. Wait one minute for additional puffs if indicated.

Dry powder inhalers require less finesse but have their drawbacks as well. A quick inhalation delivers powdered drug to the lungs without the tricky timing of pressurized canisters. An accidental exhale after the inhaler is cocked and ready to go can blow away the medication and require wasting that dose and loading a new one.

Use of dry powder inhaler:

1. Activate the dose. Depending on the drug this requires a cocking mechanism, twisting of the inhaler, or puncturing of a capsule in the device.

2. Place lips over the mouthpiece and breathe in quickly and deeply through your mouth.

3. Hold your breath for a 10-count if you can.

Some of these devices can be complicated, especially the first time they are used. Your pharmacist can demonstrate exactly how to use your particular inhaler. Never hesitate to ask your pharmacist to demonstrate.

• http://www.health.arizona.edu/health_topics/general_ health/inhaler.html

• PCCA.net

• Familydoctor.org