What is an inhaler?

The following was originally published on 11/21/11 at healthcentral.com/asthma: "What is an inhaler?"

To put it bluntly, inhalers are a gift to people with lung diseases from God.  It's asthma medicine made easy.

Albuterol inhaler

The first inhaler was invented in 1956.  It was a godsend because now asthmatics could carry with them in their pockets or purses their asthma rescue medicine.

They now had quick and easy access to their asthma medicine anywhere, any time, and any place.

While the medicine has changed over the years, the basic inhaler design is still the same.  

The key to this invention was the actuator with a one-way valve that allowed for the medicine and propellant to be sprayed in a uniform dose (a metered dose), and soon became known as the metered dose inhaler (MDI). In some countries it's called an atomizer or a puffer.

Today there are many medicines delivered by inhaler, and the inhaler market is one of the most profitable products in the pharmaceutical industry.  The Albuterol inhaler is the most commonly prescribed and most profitable asthma medicine of all time.

The neat thing about the inhaler is it allows for medicine to make it to the lungs for quick action.  Likewise, since the medicine goes directly to the lungs, this eliminates many systemic side effects of the medicine.

You can stick the mouthpiece of the inhaler into your mouth and squirt.  The medicine will still work, but you will notice that most of the medicine hits the back of your oral airway.  When this happens, most of the medicine is wasted.  

So scientists have discovered better, more efficient ways of using an inhaler.

One way is to place the mouthpiece two finger lengths away from your mouth.  You shake the inhaler well, then hold it two finger lengths from your mouth.  As you start to inhale you squirt the inhaler.  Take in as deep a breath as you can and hold your breath 5-10 seconds.

However, you want to make sure your breath is slow and easy.  If you breathe in too fast this will cause turbulance that will cause the medicine to land in your mouth before it gets deep into your lungs.  You want a slow, laminar flow.

This makes sure the more of the medicine is distributed in your air passages where it can work.  

The ideal way of using an inhaler, however,  is to use a spacer device.  Spacers help you with coordination, and it also breaks apart the large particles so what you are inhaling are smaller particles that go directly into your air passages.  

Inhaler with an AeroChamber spacer

Studies show spacers make the medicine work 75 percent better and with fewer side effects.

When I was a kid it was recommended that if you didn't want to pay for a spacer you use a toilet paper roll for this purpose.  While it's a crude design, it makes the medicine work better.

The principle of using an inhaler with a spacer is similar to the two finger technique, yet instead of space between your mouth and the inhaler there is a spacer.  You shake up the inhaler well, place the inhaler into one end of the spacer and your mouth on the spacer mouthpiece.  You squirt as you start to inhale, take in a deep breath, and hold for 5-10 seconds.  Do not remove your mouth from the mouthpiece until you are done holding your breath.

There are many different kinds of spacers, yet my favorite is the AeroChamber as seen in the picture.  This device will alarm if you inhale too fast, so the spacer actually coaches you how to inhale nice and smooth-like.

Another neat thing about the aerochamber is it allows you to squirt the medicine even before you put the spacer in your mouth.  This works well for children or elderly people who have trouble with inhaler coordination.

For smaller kids you can also place a mask on the mouthpiece end, and this helps an adult hold the mask over the child's face to facilitate coordination.

Many studies show that using an inhaler with a spacer results in better medicine distribution than nebulized medicine.  This is especially true with young kids.

I like to tell my patients to make sure your mouth stays on the spacer mouthpiece until you are done holding your breath.  This assures none of the medicine is wasted.

Regardless of what technique you use, you should take one puff and then wait 2-5 minutes to take a second puff.  When using your rescue inhaler, the first puff will open up your air passages and the second will do the mop up job.  

If you have more than one type of inhaler, you should always use your rescue medicine first and then your other inhalers second.  This allows you to get the best distribution of all your inhaler medicines as possible.

For more information about how to use your inhaler, check out this link.

Related readings are What is a Nebulizer? and Nebulizer or Inhaler:  Which one works best for your child?