How to Use a Respiratory Inhaler

As a Respiratory Therapist, instructing patients in the proper use of medical inhalers was one of my primary duties, and this was a good thing as they aren’t as easy to use effectively as one might think. In many hospitals and especially in clinics and doctors’ offices—where nary a Respiratory Therapist is to be found—nurses instruct the patients when it comes to medical inhalers, and all too often they get it wrong. Don’t misunderstand me: nurses are not inept; they simply lack much of the training that RTs receive (and RTs, on the other hand, lack enormous amounts of training when compared to nurses).

 In movies and TV shows, you always see the typecast asthmatic (usually an overweight, pale, wheezy and shy kid) stick the stubby end of the inhaler into their mouth, press down on the canister and suck up the medicine in one breathy gasp, then hold their breath for no more than a couple seconds. In reality, this technique deposits most of the medication on the patient’s tongue and the back of their throat, where it will do little more than increase their heart rate (a number of respiratory inhaler medications are stimulants). It’s a good thing that those Hollywood inhalers only contain water.

 It is crucial for the mist spraying out of the inhaler to have space to expand; this prevents it from “raining out” in the user’s mouth and more will make it into the lungs. One can achieve this by holding the mouth of the inhaler about an inch from the lips with mouth open wide, but this requires at least some coordination, and if you screw up you’ll waste medicine–and inhalers are ludicrously expensive.

 Therefore, an expansion chamber is a must. Several varieties of chamber are available through medical supply businesses. The problem with most is that they are bulky and not as easy to carry in a pocket or a purse as the inhaler. Secondly, most young people feel like a spaz when they use a chamber, even one with cool Power Ranger, Halo and Star Wars decals pasted all over it.

 One need not buy expansion chambers, however, as they are ridiculously easy to fashion at home. Simply wait until the toilet paper runs out, grab the cardboard roll before someone can throw it out and use it instead. Place the nozzle of the inhaler into one end and place the other end against your mouth, then inhale deeply about one second after depressing the canister (this pause allows the mist to expand); hold your breath for at least five seconds if possible and exhale slowly through pursed lips. You may be concerned that most of the medication will exit the tube through the spaces around the inhaler, and yes, some will escape. You can minimize this by cupping your hands around those gaps. However, even if you don’t, you’ll get a good dose of medicine and the gaps allow air to mix with the medication, which improves distribution in the lungs. Another benefit to the toilet paper roll is that it collapses easily in your pocket and if you lose it, it’s easy to replace.

It is important to follow your doctors dosing guidelines. Many inhalers are for use as needed; however, using them too often may produce problems. As I said before, some inhalants are stimulants and overusing these can cause nervousness, jitters, increased heart rate and even irregular beats. Then again, the overuse of even non-stimulant inhalers can lead to insensitivity to the medication, rendering it less effective or even useless. Many severe asthmatics have to rotate their inhalant medications to prevent this.

Never mix medications without your doctor’s approval. It’s easy to forget that inhalers deliver drugs, and often drugs will interact with other drugs either magnifying the effects, or canceling them (and some interactions can be deadly). Always follow your doctor’s advice and instructions—and if you don’t like or trust your doctor, fire his butt and get yourself another. Remember: the doctor works for you!