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Mistakes With Inhaler Technique – Practice Pearls From The Front Lines

Asthma and COPD are two disease states that we need to use inhalers. As a clinical pharmacist, I understand the importance of patient education. I’ve seen numerous mistakes with inhaler technique over the years in my practice as a clinical pharmacist. Here are some of those examples.

Shaking The Inhaler

I’ve seen this mistake go both ways. Some patients will shake everything and some will shake nothing. An albuterol inhaler needs to be shaken to properly mix the medication in the canister. Other inhalers such as Symbicort should be shaken before use as well. If patients don’t do this, they may not be getting the appropriate dose.

On the flip side, dry powder inhaler devices such as the Ellipta or Diskus products should not be shaken. I have seen some patients do this if they have used an inhaler device previously.

Mistakes With Inhaler Technique – Timing The Breath

For patients with a new diagnosis of a respiratory condition and utilizing inhaled medication for the first time, we need to understand that it does take some practice and coordination to effectively use these devices. I have seen many patients with a lack of understanding and/or coordination in being able to time the inhalation to effectively deliver the medication. In addition, I have seen many people blow directly into the delivery device which is a big no-no with dry powder inhalers.

Holding The Breath

Another one of the common mistakes with inhaler technique involves breathing again. Having the patient try to hold their breath following a strong inhalation can help that drug distribute down into the bronchioles and maximize the effectiveness of the medication. Patients who do a rapid inhalation and immediately breathe out will likely lose a significant amount of the drug out of their lungs. Virtually all inhalers require a deep breath and recommend holding your breath for 5-10 seconds or as long as is reasonable for that patient.

Handihaler Device Mistakes

I have seen and heard of a couple of examples with the Spiriva Handihaler that I think you should be aware of. I recall a patient who was attempting to open the capsules and pour the powder into the HandiHaler device. In addition, I’ve heard of patients actually swallowing the capsule that you are supposed to place in the device.

Ellipta Device Mistakes

I also want to mention Ellipta specifically because I have heard patients and healthcare professionals make mistakes in referring to the Ellipta device. It is really important to remember that “Ellipta” is not associated with only one medication. I’ve heard some individuals refer to Ellipta as the medication that they are taking. The Ellipta device can contain many different medications and when relaying this information to other healthcare professionals and/or patients, you must use the designated brand name that goes with it to specify what class or classes of medication the patient is taking. For example, Breo Ellipta contains an ICS and LABA while Incruse Ellipta contains a long-acting anticholinergic medication. I covered Incruse on a recent podcast episode and discussed some practice pearls on administration and the device. Again, Ellipta refers to the device, not the medication.

I’ve also seen patients fiddle or play with the device and lose many doses of their medication. The Ellipta device should make a click when opened and that indicates that the dose is ready to be given and the counter on the device will count it as such. If a patient opens and closes the device without taking their dose, doses will be lost.

Rinsing Your Mouth

Rinsing the mouth following administration of inhaled corticosteroids is recommended. In a previous blog post, I discussed a case scenario where a lack of rinsing following administration led to a case of recurrent infection.

What other mistakes with inhaler technique have you seen in your practice?

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Written By Eric Christianson

April 3, 2022

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