What are the steps for using an inhaler?

There are several simple steps to follow for using an inhaler:

  • remove cap
  • hold the canister upright
  • shake it
  • place it in mouth
  • actuate (release the drug) by pressing the canister in the inhaler
  • breathe in as you actuate
  • hold your breath for a few seconds
  • breathe out
  • repeat if needed

Possible side effects of using inhaled asthma drugs

Even though when using inhaled asthma drugs, a person can breathe in an adequate dose, most of the drug is actually deposited in the mouth and the back of the throat, where some irritation may occur, especially when using inhaled corticosteroids.

In addition, because corticosteroids in particular upset the balance of the micro-organisms that live in the back of the throat, a yeast infection (monilia or candida) may result, causing a hoarse voice or scratchy feeling in the back of the throat. This side effect can be reduced by gargling with water after using a corticosteroid inhaler, or by using a "spacer".

Using a spacer to improve the delivery of inhaled medications

The use of a spacer device allows more of the drug to be inhaled, and prevents the large deposition of the drug at the back of the mouth and throat. Also, less drug at the back of the throat means less drug getting into the stomach and being absorbed that way.

Using breath-actuated delivery systems

Breath-actuated systems contain the drug in a powder form. Generally, they are easier to use than metered-dose inhalers because it is not necessary to coordinate actuation (release of the drug) with inhalation.

There are four breath-actuated systems that work with specific drugs:

  • The Turbuhaler can be used to deliver a corticosteroid (Pulmicort®), a beta2-agonist (Bricanyl®), or a long-acting beta2-agonist (Oxeze®) or combination therapy Symbicort®
  • The Foradil Inhaler dispenses a long-acting beta2-agonist
  • The Diskhaler can be used for a corticosteroid (Beclovent®) or a beta2-agonist (Ventolin®)
  • The Discus can be used for a corticosteroid (Flovent®) or a long-acting beta2-agonist (Serevent®)

Using a nebulizer for the delivery of asthmatic drugs

Because nebulizers deliver larger doses of a drug than metered-dose inhalers, some people find them helpful when they are having a problem taking a deep breath. For example, when a bronchospasm is so severe that more than a few puffs from a metered-dose inhaler or breath-actuated device are needed, the asthmatic may benefit from the larger dose provided by a nebulizer. This can sometimes avoid the need for a trip to the hospital.

However, while there are some advantages to using a nebulizer, most asthmatics don't need this type of device to deliver bronchodilators or corticosteroids.

David Ostrow, MD 
in association with the MediResource Clinical Team