Tricks of the trade: Inhalers and devices

Inhaler devices are integral in the management of airway and lung diseases.

The health care provider must be familiar with the use of these devices before they prescribe them to their patients. The writing of the prescription is probably the easiest part of the process. It is essential that this is preceded by education on not only how to use the device but why the device and the medication is indicated.

In asthma, a written asthma action plan should be discussed with and provided for each patient. The patient must first be convinced of the need for the medication and the device and reassured about any worries they may have about any side effects.

There are many good devices available but their usefulness is only as good as the ability of the patient to use them correctly – not just inhaler technique but which and how much medication to take when.

Teaching inhaler technique itself involves 3 steps, explaining the technique, demonstrating the steps and, last but not least, getting the patient to demonstrate the steps. It is useful to get the patient to bring the devices for each visit but it is also important to have demonstration devices available.

If a bronchodilator and an inhaled corticosteroid are to be used at the same time, the bronchodilator should precede the anti-inflammarory.

Compliance with twice a day prophylaxis can be improved by tying it in with other twice a day habits – like brushing teeth – it then becomes a daily routine and the mouth is cleaned during the teeth brushing. 

Different devices with the same medication may hold different strengths of medication and we should be aware of this and advise our patients accordingly.

Spacer devices aid in the delivery of inhaled medication but we should be aware of the mechanics of deposition and wary of non-standard devices.

It is a journey that we take with our patients together – we must know the way and share the routes – there is more than one way to get to the destination but be wary of wrong directions!