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Wednesday, June 10, 2015

We need to teach proper inhaler technique.

There was a study performed recently showing that 93% of asthmatics do not use their inhalers correctly. Keep in mind, however, that this study consisted of 44 child and adult asthmatics in Galveston, Texas.  So I would like to see another study like this done on a grand scale to see if this percentage holds true for the entire nation.

We night assume that it probably would.  I can honestly say that I don't use my inhaler correctly.  In fact, after reading the study, I realized I don't even teach it correctly.  Do you teach your patients to shake it before each puff? I never do.  I have always told them to shake it prior to the first puff, and then it was good to go.

Actually, I wrote a posts a while back about the new inhaler recommendations.  When I was in school (actually I learned this when I was a kid) we were taught to give albuterol first, and all other inhalers later. We were taught to teach the patient to take one puff, wait a minute for the first puff to open up the lungs, and then to take a second puff 1-5 minutes later to do the mop up job.

To be honest, I still teach it this way even though the new recommendations suggests that this is no longer the case.  New evidence suggests there is no benefit from waiting a full minute between puffs.  In fact, telling people to wait only created frustration and made it so patients were less likely to take the second puff.

However, there is evidence that two puffs taken in rapid succession result in less medicine being delivered with the second actuation of the inhaler.  For this reason, it is important to wait at least several seconds between each puff.  However, experts recommend that after shaking the inhaler, and properly exhaling, and placing the inhaler in the spacer and putting the mouthpiece in your mouth, enough time should have elapsed so the second puff would expel an ideal dose.

Most asthma experts, which should include physicians, nurses, and respiratory therapists, are now taught to re-evaluate inhaler technique every time they see an asthmatic.  

This means that every time a patient comes to the emergency room to get a breathing treatment, you should have them pull out their inhaler and demonstrate proper technique.  Chances are they are doing it wrong, and it's your job to show them what they are doing wrong and how to correct it.

Now, some of you might be thinking this is overkill.  But look at major league baseball players.  Here they swing bats for a living, and yet they still only, on average, hit the ball 25% of the time.  They need constant coaching to make sure they are swinging correctly. Sometimes they need to be taught all over again to obtain an ideal swing.

The same thing is true with using an inhaler. With every doctor visit, and every hospital visit, patients should be evaluated for proper inhaler technique.

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