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Most People Use Their Inhalers Incorrectly

It has long been recognized that patients who suffer from asthma may struggle to use their inhalers properly. There are a number of mistakes that people can make when using inhalers. Research has shown that patients tend to make at least one of these mistakes 70% to 90% of the time. When these mistakes occur, the amount of the drug to reach the lungs is significantly reduced. Incorrect use can lead to only 7% of the recommended dose actually getting to the lungs.

A study was recently conducted to determine how frequently and why those with asthma incorrectly use their inhalers. The results helped to clarify the specific causes and implications for inhaler mistakes. To conduct their study, the scientists placed sensors on the inhalers of 23 patients, which allowed them to keep track of details about how the inhalers were used, including how they were shaken, activated, and breathed from. The patients included in the study were diagnosed with either asthma or chronic obstructive pulmonary disease (COPD).

Data from the inhalers with sensors showed that everyone made at least one error using their inhaler during the course of the study and that 74% of people made at least 3 mistakes. Some mistakes involve failing to follow instructions for inhaler use. Not shaking the inhaler, for instance, is one common problem that prevents the medicine from being sufficiently mixed. Another problem is that people often do not wait the suggested 15 to 30 seconds between inhaler puffs.

Other mistakes have more to do with the way patients breathe in the medicine from the inhaler. For instance, some people breathe in too quickly and miss some of the medicine. Others exhale too quickly rather than holding their breath once the inhaler medicine has hit the lungs. Coordinating the squirting of the inhaler with the breath also causes problems, as does the angle with which patients use the inhaler. Patients are advised to use an upright orientation when using inhalers, but people often lean their bodies or put the inhaler at an angle when deploying the medicine.

According to the recent study, the coordination is the most problematic mistake that occurs with inhalers because mis-coordinating by as little as half a second reduces the amount of medicine that reaches the lungs to 20% of the intended amount. Not breathing deeply enough was reported as the second most dangerous error that occurs during inhaler use.

The researchers noted that there are certain populations that are more likely to struggle with coordination and breathing deeply while using their inhalers. Specifically, elderly patients, children, and those with cognitive impairments have been shown to be less likely to successfully coordinate their breathing with the activation of the inhaler and less likely to breathe deeply enough to get optimal results.

These research findings point to the need for physicians and patients to work together to ensure that inhalers are being properly used. Rather than assume that patients are getting the recommended dose of their medicine, physicians need to be aware of the difficulties associated with the deployment of the medication and to focus some time on minimizing these challenges, particularly in populations that are prone to have trouble with the proper use of inhalers.

To mitigate the problems associated with improper use of inhalers, researchers have also suggested the use spacer devices, which are tubes that are attached to inhalers. These tubes can help deliver the medicine properly.  With progress in both technology and physician-patient communication, the effective use of inhalers can likely improve.

Dr. Summit Shah

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