October 19, 2006

The respiratory therapists of the American Association for Respiratory Care are celebrating Respiratory Care Week (Oct. 22-28) by focusing on correct inhaler usage and offering an online tutorial to help you learn about your inhalers.

“There is a great need for patient education about the proper use of inhalers,” said Sam Giordano, executive director of the American Association for Respiratory Care. “Patients aren’t being taught which inhaler to use at the correct time, and for many who are using the correct inhaler, they haven’t been taught the proper technique.  If a respiratory patient isn’t using the device correctly, the needed medication is not getting to their lungs. They are only getting a portion of the dose. It could be compared to patient receiving only three-quarters of a pill from the pharmacist. No responsible medical professional would allow it, but that is what is happening with inhaled medications. We need to educate the patients and this tutorial addresses that need.”

Studies have shown that respiratory patients are not trained to use the correct inhalers and an even larger percentage use the incorrect technique prohibiting the delivery of the medication to their lungs.

Even more alarming is a study which examined the knowledge of medical professionals and concluded:

“Medical personnel responsible for teaching the correct use of inhalationaldevices are lacking in basic knowledge and user skills. This likely contributes to patient's poor technique when using these devices.”

Of the medical personnel evaluated for their skill and knowledge of inhaler use, respiratory therapists rated the highest with 81.6 percent efficiency.

The tutorial is being launched in conjunction with the 25th anniversary of Respiratory Care Week (Oct. 22-28), a week dedicated to the recognition of the 134,000 respiratory therapists in the United States who work to help patients with lung disease. As standard practice, respiratory therapists are trained to educate patients about proper use of inhalers including technique.

“It’s very difficult for many patients who are taking three or four inhalers everyday to remember which one to take and at the correct time,” said Giordano.  “Until they have developed the proper habits and can visually identify the correct inhaler, it’s confusing and mistakes are made which has led to patients suffering.”

Asthma patients usually have two inhalers prescribed to them, the rescue medication to quickly treat an asthma attack and a controller for daily use to help avoid attacks. The U.S. Food & Drug Administration cites an incident in which a patient suffering an asthma attack was confused about which inhaler to use. The patient took the controller, the asthma attack worsened and the patient died.

The AARC encourages patients to place a large “X” on their rescue medications, so they will immediately identify the correct inhaler to use during a severe respiratory attack.

The Asthma Patient
According to a recent study, many asthma patients are using the wrong inhaler to treat their wheezing with 31.6 percent saying they used something other than a bronchodilator, a rescue medication like albuterol.

Another issue for patients is knowing when their inhalers have run out of medicine. Patients have no reliable means of knowing how many doses are left in their inhalers. There are 200 actuations in an albuterol canister and the FDA recommends keeping count through a diary.  The study reports that almost 20 percent of the respondents refilled their inhaler once per month to guard against having an empty inhaler during an attack. The AARC recommends purchasing a dose meter at the pharmacy to help track the medication.

The COPD Patient
Whereas the asthma patient will use two inhalers, a typical COPD (chronic obstructive pulmonary disease) patient is taking four inhalers including a steroid, short-acting beta agonist, anticholinergic and long-acting beta agonist. Each of these medications works differently to help open up the airways or reduce inflammation, so the patients can breathe easier. But each medication needs to be taken as prescribed to work properly.
In hospitals, respiratory therapists help physicians select the appropriate device since not every patient can use each device due to physical or mental limitations. Many COPD patients are elderly and may need instruction and re-education on the proper use of the inhaler. Once the patients leave the hospital, the confusion begins.

 “There are too many patients trying to figure this out on their own, and fail,” said Giordano. “We recommend that they stay in touch with a respiratory therapist or contact their attending physician if they are uncertain about which inhaler to use or how to use it. That is why this new tutorial will help. If they have access to a computer, they can check the AARC Web sites for some quick information. I would recommend they print it out and have it available for quick reference.”

 

1 Guidry, CG; Incorrect use of metered dose inhalers; CHEST, (1992) Vol. 102, Issue 3, Page 979.
2 Chopra, N.; Oprescu N.; Fask A.; Oppenheimer J. (2001 November). Does introduction of new easy to use inhalation devices improve medical personnel’s knowledge of their proper use? Annals of Allergy, Asthma, & Immunology, 2002, Volume 88, pp. 395-400.
3 Sander N. et al, Dose counting and the use of pressurized metered-dose inhalers; running on empty.  Annals of Allergy, Asthma & Immunolog, 2006;97:34-38.