inhalers

Using your inhalers

USING AN INHALER IS THE MOST COMMON WAY OF TAKING ASTHMA MEDICINES. IT IS ALSO A VERY EFFECTIVE WAY BECAUSE INHALING THE MEDICINE TAKES IT STRAIGHT INTO YOUR LUNGS.

Most people with asthma use an inhaler to take their asthma medicines. An inhaler is very effective because it helps you breathe your medicine straight into your lungs where it's needed. Using an inhaler means you get the medicine quickly. You're also likely to get fewer side effects when you use an inhaler to get medicine into your airways, because not much of the medicine is absorbed into the rest of your body.

It's important to go through your written asthma action plan with your GP or asthma nurse during your asthma review as this will explain when to increase or decrease your inhaler use to help you get more from daily life.

How does a good inhaler technique help you to manage your asthma?

The aim of managing asthma is to put you in control of your condition rather than letting the asthma control you. Using your inhaler correctly can help you manage your asthma better because you're getting the correct amount of medicine into your lungs where it can work to reduce your asthma symptoms.

For example, if you're using your preventer inhaler regularly and correctly, it can help you to stop being breathless climbing stairs; to cope better with your triggers such as pollen, cold weather, dust, pollution or pets; to sleep better as you won't be coughing at night; to have less time off work or school; and to take part in exercise and family activities. It also cuts your risk of an asthma attack.

Are you using the correct inhaler technique?

Some people have told us that inhalers can be tricky to use, and even if you think your inhaler technique is correct, it might not be! A recent survey we carried out found thatup to a third of people with asthma aren't using their inhaler in the right way.

If you're NOT using your inhaler correctly, you might not be getting the full dose of medicine your GP or asthma nurse prescribed because the medicine can't reach your lungs. Instead it might be hitting the back of your throat, or staying on your tongue or in your mouth where it won't help at all. Using the wrong technique can also mean you're more likely to get side effects, such as oral thrush or a sore throat.

Getting your inhaler technique checked

• Ask your doctor, asthma nurse or pharmacist to show you how to use all your inhalers correctly - when they're first prescribed, if you're unsure that you're using them correctly and again at each annual asthma review. They can tell you how many puffs a day you need to take and exactly when and how to do it. You can see from the list above that there are lots of different types of inhalers and that they work in different ways. If it's been a while since you were last shown, it's easy for little mistakes to slip into your routine, or you may need to update your technique because the design of your inhaler may have changed.
• Ask a friend or family member to come along to your appointment - they can remind you how to use your inhaler if you forget.
• Keep a diary of your asthma symptoms and peak flow before and after having your inhaler technique checked so you can notice any improvements in your symptoms.

Types of asthma inhalers and how to use them

There are different kinds of asthma inhalers, with different types of medicine in them. Because these inhalers are used in different ways you may find some easier to use than others. Your GP or asthma nurse can talk you through the different types of inhaler devices available and help you to decide which one is best for you.

If your GP or asthma nurse hasn't discussed your options with you, ask them if the inhaler you're using is the best one for you at your next asthma review.

Inhalers come in lots of different colours. Relievers are usually blue and preventers are usually brown (but some can be orange). This list is a general guide to the different types of devices, but you can find videos with specific instructions for your inhaler at the bottom of this page.

• 'Press and breathe' metered dose inhalers (MDIs) are often called 'puffers'. MDIs work better with a spacer, especially for children. Spacers collect the medicine inside them, so you don't have to worry about pressing the inhaler and breathing in at exactly the same time. This makes these inhalers easier to use and more effective.
  An MDI inhaler uses a small canister with a mixture of your medicine and a gas or liquid that turns the medicine into a very fine spray as you press on the canister. Most people call this a 'puff' of medicine. To get the best result you should shake the inhaler before each puff so that the medicine mixes well before use.
• 'Breathe in normally' breath actuated MDIs are usually given to people who have difficulty using a standard 'puffer'. These inhalers are activated by your breath so that when you breathe in normally through the mouthpiece, it releases medicine in a fine spray form. With this inhaler you don't have to push the canister to release a dose. Autohaler and Easi-breathe are examples of breath actuated MDIs. You need to shake these inhalers before each puff so that the medicine mixes well before use.
• 'Breathe in hard' dry powder inhaler (DPIs) release medicine in very fine powder form instead of a spray when you breathe in through the mouthpiece. You need to breathe in fairly hard to get the powder into your lungs. Examples of DPIs include Accuhalers, Clickhalers, Easyhalers, Novolizers, Turbohalers, Diskhalers and Twisthalers.

Are you making any of these common mistakes with your inhaler technique?

FOR ALL INHALERS:

• Not breathing out first. When you breathe out fully (or as much as you comfortably can) just before taking your inhaler, you create more space in your airways for your next breath in. This means that you can breathe in deeper and for longer when you inhale your asthma medicine - giving it the best chance of reaching the small airways deep inside your lungs, and being most effective.
• Not holding your breath after taking your inhaler. If you've been advised to hold your breath after taking in your inhaler, it's very important to do so. When you hold your breath after inhaling the medicine, you are keeping your airways still. This gives more time for the medicine to get into your lungs. If you can hold your breath for 10 seconds, this is ideal but if this isn't possible, you will still benefit by holding it for as long as you feel comfortable.

IF YOU HAVE A 'PRESS AND BREATHE' MDI INHALER:

• Not shaking your MDI before use and between puffs. If you don't shake the canister, the asthma medicine and propellant (the substance which helps turn the medicine into aerosol form) will not mix together properly and too much or too little of one will be released.
• Inhaling too early before pressing the canister. If you're already half way through breathing in by the time the medicine is released from the inhaler, you won't have enough time to finish breathing in all the medicine because your lungs will already be full. If this happens, some of the medicine will end up being sprayed in your mouth and hitting the back of your throat and not being carried down to your lungs where it's needed.
• Inhaling too late after pressing the canister (unless you're using a spacer). It takes less than half a second from the time the canister is pressed for all the medicine inside the inhaler to be released. If you breathe in after this time, some of the medicine will end up being sprayed in your mouth and not being carried down to your lungs where it's needed.
• Not leaving enough time between doses. You need to give your inhaler a good shake between doses and then wait at least 30 to 60 seconds before taking the next puff. This gives the medicine and propellant enough time to mix together.

Get the best from your inhalers

Use these simple tips to make sure you get the best from your inhalers in between your annual asthma reviews. This will help ensure you get the right dose of your medicines to keep your asthma symptoms as well controlled as possible.

1. CHECK YOUR INHALER TECHNIQUE IN BETWEEN ASTHMA REVIEWS

• You can use these videos to check your technique, and remind yourself of each important step.
• You can use this document from the Global Initiative for Asthma that shows diagrams and user instructions for some of the inhalers.
• You can pop in to see your local pharmacist anytime (you don't need an appointment) to ask them to check your technique.

2. AVOID ORAL THRUSH AND/OR A SORE THROAT AFTER USING A PREVENTER INHALER THAT CONTAINS STEROIDS

• Make sure you're using the correct inhaler technique
• Brush your teeth, rinse out your mouth or gargle and spit out, after using your preventer inhaler
• Use a spacer with your preventer inhaler

3. STORE YOUR INHALERS CORRECTLY

• You should always keep the inhaler cap on when you're not using it. People who use inhalers have told us that sometimes things have got stuck in the mouthpiece of their inhaler because they've stored it in their handbag or drawer without its cap on. This can be dangerous because there's a risk you might inhale the stuck object when you next use your inhaler.
• Store your inhaler at the correct temperature. Extreme temperatures and/or high altitudes can affect the medicine in your inhaler. Check the label on your inhaler for storage instructions. Don't leave your inhaler where it might get too hot or cold (for example in your car or conservatory). Speak to your GP about how to look after your inhaler if you're planning to go on holiday to a hot or cold country, or if you're going mountain climbing.

4. CLEAN YOUR INHALERS THE RIGHT WAY

Cleaning and properly maintaining your inhaler isn't difficult, but a couple of handy tips can make sure you don't affect how well they work.

Cleaning your 'press and breathe' metered-dose inhaler. Follow the cleaning instructions that come in the box with your MDI. The most important thing to remember is to never wash the metal canister or put it in water - only wash the plastic parts.

1. Remove the metal canister from the plastic casing of the inhaler and remove the mouthpiece cover.
2. Rinse the plastic casing thoroughly under warm running water.
3. Dry the plastic casing thoroughly inside and out.
4. Put the metal canister into the plastic casing, test it by releasing a single puff into the air and replace the mouthpiece cover.

Cleaning your dry powder inhaler:

1. Wipe the mouthpiece of your dry-powder inhaler with a dry cloth at least once a week.
2. Do NOT use water to wipe the dry powder inhaler because the powder is sensitive to moisture.

For more information...

The patient information leaflet (PIL) is the leaflet that's included in the box with a medicine. The PIL explains the best way to use, clean, store and look after your inhaler. If you're unsure about anything or have any questions about the PIL, speak to your GP, pharmacist or asthma nurse.

If you've lost or misplaced your PIL you can download an electronic copy:

• visit the electronic Medicines Compendium (eMC) website
• type in the name of the medicine in the search box
• click on the option which has a purple circle with 'PIL' written inside it
• download the PDF (click on the downward facing arrow on the left-hand side of the screen which says 'view patient information leaflet'

https://www.asthma.org.uk/advice/inhalers-medicines-treatments/using-inhalers/