Ask The Pharmacist – Inhalers
In the United States, 1 and 8 people have asthma or Chronic Obstructive Pulmonary Disease and many more will need to use an inhaler due to pneumonia or infectious bronchitis over their lifetime. While inhaled medications are a mainstay of treatment for these lung diseases, the drug needs to reach the lungs to be effective. Current estimates state that only 1 in 5 people optimally use their inhalers, wasting money and increasing the risk of adverse effects
With other 40 million people suffering from asthma or COPD, the need for effective therapies is tremendous. The two main types of inhaled drugs include beta-2 agonists which open up the bronchioles and corticosteroids which reduce lung inflammation. If these inhaled drugs were given as pills, they would be given in much higher doses because it would travel all over the body in the blood and only the part reaching the lungs would benefit the patient. By inhaling the drugs, you can get higher lung concentrations with only small amounts of drug in the bloodstream. So while there are many advantages to inhaling the medicine, you have to be able to do it correctly.
There are several different types of inhalers. The first is the metered dose inhaler which everyone is familiar with. With this device the drug is dissolved in tiny droplets that you inhale. We have all seen it used in the movies. However, this approach uses turbulant airflow which results in more drug being stuck to your mouth and less making it down into your lungs. When using an inhaler first shake it 4 or 5 times to disperse the droplets as well as you can, breathe out all the air from your lungs and place it in your mouth, start breathing in slowly and then press down on the canister to release the drug. Continue to breathe in slowly until you have a full breathe and hold your breath for a ten seconds before breathing out. This will get much more drug into your lungs. People are not as familiar with the diskus or aerolizer inhaler but here the drug is in a fine powder, not a liquid so the technique is very different for these. For the diskus, you open it up, puncture the capsule inside the diskus by pulling this lever, wrap your mouth around the diskus creating a seal, and then suck in hard until your lungs are filled to get the powder into your lungs. Still hold your breath for ten seconds to get the remaining powder in your windpipe down into your lungs before breathing out. The breathing technique is the same for the aerolizer inhaler except here you are loading the capsules into the inhaler manually. So you open it up, place the capsule into the chamber, close it and then push the two buttons to puncture it. Then you breathe in just like with the diskus.
Dr. C. Michael White; Professor/Head Of Pharmacy Practice, Univ. Of Ct Health Center provides advice every Tuesday