This is something that I wouldn’t say bugs me but it is a gripe.
When I go to have my asthma review with my health centre (which I think is a waste of time- because not wanting to be big headed but I end up teaching them more about asthma than they tell me!!!) But to the point. They always tick on their sheet that they have done the inhaler technique review. I have never once been asked to show them my inhaler technique. I think it is possible that they think that because I have taken them for so long I must know how to take them. But is think that the longer you take them the more your inhaler technique should be reviewed as you are likely to develop bad habits. When I think about it, it is not only at my health centre the hospital do it as well. There have been so many times i ahve seen such bad techniques and jsut want to go and tell people that they doing it wrong and how to do it but i always refrain.
Here are some of the techniques I have seen!
1) giving it a good shake then holding it about5 inches from your mouth and squirt and try and catch it (no joke catch it. the person head moved forward as though they were catching somethign in their mouth!!!)
2) a good shake given again and holding the inhaler jsut outside an open mouth and giving four puffs and keeping ones mouth open and i could see the inhaler mist out the side (well not mist but you know when you can see inhaler when you spray it!)
3) a good shake and the inhaler held upside down and puffed into the mouth. the mouth was closed but immediatly opened after the puff.
4) the inhaler is sprayed as the person is breathing out! so it came out the top!!!
These are just a few of the different inhaler techniques I have seen. I always have tried to make sure myinhaler technique is right. I know it probably isn’t and I have probably developed bad habits but I’m only human. You cant blame people for having bad inhaler techniques because if others experiences are the same as mine then you don’t get taught how to have a good technique and what is a bad technique.
I know it is difficult to know the right way and wrong way for all the inhalers. I have three different types of inhaler and all have different techniques of using it which is a bit confusing and when your in a rush you don’t always have time to stand and breathe out deeply and then in and take inhaler and hold your breath and then repeat this if you have a few puffs to do etc.
This is a pic I found on the internet when looking for different inhaler devices as there are so many but i think its quite a good poster!
Peak flow is also another one as results can vary hugely depending on your technique. Also I haven’t seen random techniques for this as you don’t tend to do a peak flow on the bus or up town shopping!!!!
I know there are some followers of this blog from other countries and wondered what you healthcare providers are like with inhaler techniques and things?
ANONYMOUS-ASTHMA 
When I first got an inhaler, I was pretty much clueless as to how to use it. Odd thing is, the one and only doctor/medical person who’s ever watched me use my inhaler to see if my technique is right is the pharmacist who taught me how to use it. My GP has emailed me numerous times descriptions on how I should use my inhaler, but none of my doctors have ever seen me use it. However, this does not mean I’ve had perfect inhaler technique… quite the opposite. 😛
It took me a day or two to realize that I had to inhale in through my MOUTH, not my nose. Whoops.
Then, several weeks later I was given a aerochamber. I loved it from the moment I first used it. The bad thing though, is that it totally destroyed whatever spacer-less technique I had. Several weeks later I didn’t have my spacer with me, and totally messed up the coordination between pressing it down and inhaling: it all landed in my mouth. Whoops.
When I tried Asmanex twisthaler several months ago, my GP told me to make sure to talk with the pharmacist about how to use it as it was different from MDIs. So, I explained this to the pharmacist and she got another pharmacist to come. That one was about as clueless as me. She told me she didn’t know, so we were going to learn together. So, she opened the box, and took out the instruction leaflet, and read the steps aloud to herself and tried to help me understand at the same time too. Except, I have a feeling I was the one helping her figure it out more than she was helping me. 😛
“I haven’t seen random techniques for this as you don’t tend to do a peak flow on the bus or up town shopping!!!!” LOL! Funny but oh, so true.
My GP is HUGE on the ‘always use your spacer’ thing. So was my old pulmonologist, and I’m not sure about my new one…. other than he emphasizes extra with me to rinse my mouth out after the inhaled ‘roids as I’ve gotten thrush more than once recently.
I was interested to read this that you got your technique from your pharmacist but also you gp emails you with sheets about it. At least that is a step in the right direction and they do register that inhaler technique has to be addressed but sometimes they don’t even discuss it. There is a need for extra to be done. Yes washing you mouth out it a must with inhaled steriods. They are a pest when causing thrush. I have had it a few times. Not pleasent and i find i cant eat properly because my mouth get so sore.
I’ve NEVER had instruction on MDI technique until I saw an RT for spiro a few months ago (after taking inhalers for nearly two years). I have a post somewhere about her flip-out on me because I stuck my inhaler in my mouth. She wanted me to do the open mouthed inhale thing (with the spiro inhaler. No thank you, I will use my own). So, I made her happier and pulled out my spacer (so she started spouting percentages of medication deposition in the lungs at me, ughhh).
The asthma educator/RT I saw didn’t check my MDI technique which surprised me (but she was happy that I used my spacer when I knew I was breathing really crap or when I was at home, but understood about not wanting to use it in public. My RT rocked). She did however check my technique with the Symbicort turbuhaler to make sure I had enough suck power in me to get the stuff down ;-). They have these cool demo turbuhaler things that make whistling noises if you breathe in properly.
Funny enough, I’m a HUGE spacer advocate, and until I saw that RT, NOBODY ever told me to use a spacer, I just did because when I got my first inhaler, I COULDN’T use it without the spacer. Even now, I usually have it with me, but if I’m out and need to use the spacer, I’ll be sneaking off to the bathroom ;-).
Two of my friends both have really crap inhaler technique and don’t use spacers ever. One of my friends one day took two hits of FloVent and two hits of Ventolin, and I just sat there reciting all the stuff she was doing wrong in my head, but I didn’t want to be a jerk or seem like a know it all so I said nothing (I’ll probably say something next time though…). She didn’t use a spacer (which I would ALWAYS use with MDI steroids), she didn’t hold her breath, she didn’t wait at ALL between puffs . . .
Great post topic, Olive!
I think when you use a spacer there is not much technique needed and you can get away with a bad technique more than you can when you dont use a spacer mainly because the inhaler isnt going anywhere. Once it has been sprayed it stays in the chamber till you breathe it in.
I ahve to say I never use a spacer really. I only use a spacer if I am not using a neb and taking multiple doses of ventolin instead of a neb otherwise i dont bother using a spacer. I think it stems back to being young and the spacers were too big to carry about so I jsut took it without one. When out and about I am kinda use to using my neb in public that is doesnt bother me now. People still stare but I jsut stare back!!! I kidna think if i need to use it i need to use it and am not gonna go away to the toilet to use it because its not my fault i need it so why should others be bothered by it.
Even after over 20 years of using an inhaler I still have bad habits! One which me and my cf friend do is when we are really breathless is take about 5 puffs all at once, hmm yer like thats gonna help! I always watch others doing there inhalers and all of them most deffinetly would benefit from the use of a spacer. My gp for some reason changed my vent MDI to an easibreath and I just dont have the puff to use it, so I take the top off and use it as an MDI.
Just ask drs to change it back…easibreathes are more expensive so they would probs gladly change you back!!! Also you can ask gp for a spacer they pretty cheap and eays to use. Coz a neb isnt always needed sometimes!