by Jason Henderson
Millions of people rely on inhalers to manage chronic obstructive pulmonary disorder (COPD), a progressive lung disease that affects approximately 30 million Americans and is the sixth leading cause of death in the United States. Despite the critical role of inhalers in treating COPD, a recent European study has found that improper inhaler use is rampant, contributing to worsening symptoms and poor disease management.
The study, led by Dr. Gaël Grandmaison of the University and Hospital of Fribourg in Switzerland, found that two-thirds of inhalers were misused, leading to inefficient symptom control, reduced quality of life, and increased hospitalizations. The findings were published in the journal Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation and shed light on the need for better patient education and tailored inhaler solutions.
Why Inhaler Misuse Is So Common
COPD patients face several challenges when it comes to inhaler use. In Grandmaison’s study, the researchers analyzed 160 inhaler devices used by 96 COPD patients. A staggering 69 percent of inhalers were used improperly, mainly due to “critical errors” in the patients’ inhalation techniques. Another 17 percent of inhalers were found to be unsuitable for the patients using them.
Several factors contribute to this widespread misuse:
- Inhalation Technique: Some inhalers require a strong and deep inhalation effort to ensure the medication reaches deep into the airways. COPD can be a physically debilitating condition, making it difficult for some patients to muster the necessary inhalation force.
- Manual Dexterity and Cognitive Impairment: COPD often affects older adults, many of whom struggle with arthritis, poor motor control, or cognitive issues. These factors can hinder their ability to use inhalers properly.
- Unsuitable Inhalers: In some cases, patients are prescribed inhalers that are not well-suited to their individual needs, making it even harder to use them effectively.
The consequences of improper inhaler use are severe. Misuse leads to poor symptom control, frequent exacerbations, and increased reliance on healthcare services, all of which negatively impact the lives of COPD patients.
Importance of Education and Training
Dr. Grandmaison’s study highlights the importance of regular education and assessment for COPD patients. In his hospital, physiotherapists conducted up to three teaching sessions with patients who misused their inhalers. These sessions significantly reduced critical errors, but about 10 percent of patients continued to struggle, either due to an inability to generate sufficient inhalation effort or because the inhaler was unsuitable for their condition.
Dr. Valerie Press, an associate professor of medicine at the University of Chicago, also emphasized the need for enhanced patient education. “Many clinicians — and often even the patients themselves — are unaware that patients are having difficulty getting enough medication into their lungs,” she noted. Continuous training is essential, particularly when multiple inhalers are prescribed.
Tips for Proper Inhaler Use
Using an inhaler correctly is key to managing COPD effectively. Here are some practical tips to help ensure proper inhaler use:
- Understand Your Device: Inhalers come in different types, such as metered-dose inhalers (MDIs) and dry powder inhalers (DPIs). Knowing how your specific device works is crucial. Ask your doctor or pharmacist to explain the steps clearly and demonstrate if necessary.
- Follow Instructions Carefully: Read the instructions that come with your inhaler and follow them step by step. Some inhalers require shaking before use, while others may need you to load a dose before inhaling.
- Breathe Out First: Before using your inhaler, exhale completely to empty your lungs. This creates space for the medication to enter your airways effectively.
- Inhale Slowly and Deeply: For MDIs, it’s important to inhale slowly and deeply as you press the inhaler to release the medication. For DPIs, a quick and forceful inhalation may be required. Practice the correct technique for your inhaler type.
- Hold Your Breath: After inhaling the medication, try to hold your breath for 5-10 seconds to give the medicine time to settle in your lungs. Then exhale slowly.
- Rinse Your Mouth: Some inhalers can leave residue in your mouth, leading to irritation or infections like thrush. Rinse your mouth with water after each use to prevent these issues.
- Use a Spacer (if needed): If you’re using an MDI, a spacer can help ensure the medication is delivered to your lungs rather than your mouth and throat. Ask your doctor if a spacer is right for you.
- Regularly Check Your Technique: Have your inhaler technique evaluated periodically by your healthcare provider. COPD symptoms can change over time, and so can your ability to use an inhaler correctly.
- Keep Your Inhaler Clean: Follow the cleaning instructions for your device. A clogged or dirty inhaler won’t deliver the medication properly.
- Monitor Your Symptoms: Pay attention to how you feel after using your inhaler. If your symptoms are not improving or are getting worse, speak to your doctor. You may need a different type of inhaler or additional training on proper use.
The widespread misuse of inhalers among COPD patients is a significant concern that contributes to poor disease management and deteriorating health. However, through proper education, tailored inhaler prescriptions, and regular evaluations, patients can greatly improve their ability to manage their symptoms and enhance their quality of life. If you have COPD, speak with your healthcare provider to ensure you’re using your inhaler correctly—your health depends on it.
