How to use an Asthma inhaler the right way

Asthmatic inhalers are devices designed to facilitate drug delivery to respiratory structures to relieve an asthma attack or chronic Obstructive pulmonary disease (COPD).

There are different designs of devices approved for use and each of them requires learning their specific techniques and skills involved to obtain maximum benefits. Commonly used ones include : pressurized metered dose inhaler (pMDI), respimat inhaler (tiotropium), Accuhaler (seretide), turbohaler (symbicort).

How to use a metered dose inhaler

Ideally used via a spacer. However, some people find it inconvenient to carry spacers with them. Hence, the need to learn how to use it without a spacer. 

Steps to follow in using your Asthma inhaler

1. Remove the cap of the inhaler, hold the inhaler upright and shake it well. 
2. Breath out gently away from the device 
3. Put the mouthpiece between your teeth without biting 
4. Form a good seal with your lips 
5. Start to breathe in slowly and at the same time press the canister firmly with your finger. 
6. Continue to breathe in slowly and deeply as long as comfortable 
7. Hold your breath for about 10 seconds or more and then breathe out slowly away from the device. 
8. Repeat these steps if you require a second dose. 
9. After each use, wipe the mouthpiece with a dry tissue and then replace the cap. 
10. Rinse your mouth with water. 

NB: When your puffer is finished, get back to your pharmacist to get you a new device. Always let your pharmacist check your technique to optimize your benefits from the device use.

How to use an accuhaler?

An Accuhaler is a breath-activated device meaning that you inhale a dose when you inhale through the mouthpiece. The device is preloaded with the medicine in foil packets of  60 doses. These doses can be counted as indicated in the dose counter.

Steps involved with use of an accuhaler

1. To open your Accuhaler, hold the outer case in one hand and put the thumb of your other hand on the thumb grip. Push your thumb away from you as far as it will go. You will hear a click. This will open the device to reveal the mouthpiece. 
2. Hold the Accuhaler with the mouthpiece towards you. 
3. To load your inhaler, slide the lever away from you as far as it will go until you hear a click. This will open a small hole in the mouthpiece. Nb: any time the lever is pulled back a blister is opened inside and the powder made ready for inhalation. Do not play with the lever as you will be wasting your medicine. 
4. Hold the Accuhaler away from your mouth 
5. Breath out as far as possible. Nb; do not breathe into the device. 
6. Put the mouthpiece to your lips 
7. Breathe in steadily and deeply from the Accuhaler through your mouth, not through your nose. 
8. Remove the Accuhaler from your mouth. 
9. Hold your breath for as long as comfortable (10 seconds preferably)
10. Breath out slowly 
11. Rinse your mouth with water and spit out or brush your teeth. 
12. Slide the thumb grip back towards you until you hear a click indicating the device is closed. 
13. The lever will return to its original position and reset. 
14. Always wipe the mouthpiece with dry tissue after each use. 

How to use a respimat inhaler

This comes with a device and a cartridge. Normally the pharmacist will preload it for you. In case it is not preloaded, follow the steps below to prepare for use. 

1. Remove clear base

• Keep the cap closed.
• Press the safety catch while pulling off the clear base with the other hand.

2. Insert cartridge

• Insert the cartridge into the inhaler.
• Place the inhaler on a firm surface and push down firmly until it clicks into place.

3. Track cartridge

• Mark the check-box on inhaler’s label to track the number of cartridges.
• Put the clear base back into place until it clicks

4. Turn

• Keep the cap closed.
• Turn the clear base in the direction of the arrows on the label until it clicks (half a turn).

5. Open

• Open the cap until it snaps fully open.

6. Press

• Point the inhaler toward the ground.
• Press the dose-release button.
• Close the cap.
• Repeat steps 4-6 until a cloud is visible.
• After a cloud is visible, repeat steps 4-6 three more times.

The inhaler is now ready to use and will deliver 60 puffs (30 doses).

Daily use of the inhaler 

1. Turn

• Keep the cap closed.
• TURN the clear base in the direction of the arrows on the label until it clicks (half a turn).

2. Open

• OPEN the cap until it snaps fully open

 3. Press

• Breathe out slowly and fully.
• Close the lips around the mouthpiece without covering the air vents. Point the inhaler to the back of the throat.
• While taking a slow, deep breath through the mouth, PRESS the dose-release button and continue to breathe in slowly for as long as comfortable.
• Hold the breath for 10 seconds or for as long as comfortable.
• Repeat TURN, OPEN, PRESS for a total of 2 puffs.
• Close the cap until the inhaler is used again. 

NB: Obtain a new cartridge when dose is less than 10. Follow the same steps to replace a new cartridge.

How to use a turbuhaler?

Preparing  your  new  Symbicort  Turbohaler 

Steps 

1. Unscrew the cover and lift it off. You may hear a rattling sound.  
2. Hold your Turbohaler upright with the red grip at the bottom. 
3. Turn the red grip as far as it will go in one direction. Then turn it as far as it will go in the other direction (it does not matter which way you turn it first). You should hear a click sound. It does not matter whether the click comes on the first or the second twist.  
4. Do this again, turning the red grip in both directions. Your Turbohaler is now loaded and ready for use. 

How to  take  an  inhalation each time.

1. Unscrew the cover and lift it off. You may hear a rattling sound.
2. Hold your Turbohaler upright with the red grip at the bottom.
3. Do not hold the mouthpiece when you load your Turbohaler. To load your Turbohaler with a dose, turn the red grip as far as it will go in one direction. Then turn it as far as it will go to the other side. You should hear a click, it doesn’t matter whether it comes with the first or second twist. 
4. Hold your Turbohaler away from your mouth. Breathe out gently (as far as is comfortable). Do not breathe out through your Turbohaler. 
5. Place the mouthpiece gently between your teeth. Close your lips. Breathe in as deeply and as hard as you can through your mouth.  
6. Do not chew or bite on the mouthpiece.   
7. Remove your Turbohaler from your mouth. Then breathe out gently. The amount of medicine that is inhaled is very small. This means you may not be able to taste it after inhalation. If you have followed the instructions, you can still be confident that you have inhaled the dose and the medicine is now in your lungs. 
8. If you are to take a second inhalation, repeat steps 2 to 7.
9. Replace the cover tightly after use.   
10. Rinse your mouth with water after your daily morning and/or evening doses, and spit it out.

References https://www.medicines.org.uk/emc#gref