Perfect Puff

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Every single morning, the very last thing I do in the bathroom is grab my two inhalers. Shake them (1,2,3…all the way to 15). Exhale slowly, and then inhale slowly through my mouth (1,2,3,… up to 10), depress the button on 2 , and then exhaling through my nose. Repeat the process for the other inhaler.

Inhalers

Years ago, I used a machine and liquids. But, the government thought that most people wouldn’t adhere to that regimen, so they stopped everyone from choosing that process. (The same way the government disallowed folks who wanted to make their own contact lens solution; ones without those preservatives that annoyed our eyes.)

The problem is that most folks still use their inhalers incorrectly. So, they don’t garner the benefit of those expensive drugs they buy. (My two inhalers cost $372 and $ 454. If I used them as frequently as my doc decided, those would be monthly costs; however, I monitor my results and know that one puff a day keeps my doctor at bay. Cutting those costs per month by half.)

According to medical professionals, patients screw up as often as 9 times out of 10! So, those folks only receive some 7 to 40% of the required dosage in their lungs. That is despite that many use ‘metered dose’ inhalers. (That sort of device means a specified amount of drugs is released with each puff of the unit.)

The biggest problem? Most folks don’t shake their device. Or, they just shake it before taking their first puff- and not agin prior to  the subsequent one(s). If the unit isn’t shaken, then the medicine is not dispersed with the propellant. That means you get little, if any, drugs as part of that puff.

Or, some subjects tilt their heads or their inhalers. That sends the drug directly to the roof of their mouths or to their tongues. Except not to their lung’s airways, where it can do some good.

Some folks only inhale after activating the inhaler. Which keeps the full drug dosage from reaching the lungs. Or, they inhale too quickly- yielding the same result. Or, they don’t hold their breath long enough (counting to 10), which means the drug fails to get a chance  to settle on the lung interior surfaces.

One also needs to wait some 10 to 30 seconds before taking that second dose. (This is where shaking the unit before each puff really helps! The lungs get the respite needed before the next puff, as one shakes.)

Drs. N. Hanania, A. Sabharwal, A. Mosin, along with Mssrs. Biswas and Patel of Rice University provided the results of their two research studies on inhaler usage.  The first was presented at CHEST.  Metered dose inhalers were attached to a Capmedic device. The Capmedic monitors how many shakes, the shake force, breathing rates, inhaler activation, the angle of the device among the parameters of use. The researchers, in this report, reported everyone screwed up at least once, and 74% missed the rules at least thrice. Half the subjects never shook their inhalers properly- or at all.

The second presentation was an article in the Journal of Aerosol Medicine and Pulmonary Drug Delivery (this credited only three of the researchers [Hanania, Subgarwal, and Biswas ]).  Using the data from 15 subjects, the team developed an airflow model discerning drug deposition (in this case, ventolin) in the lungs. This model is how one can predict what happens as a patient screws up their inhaler practices.

The biggest effect? Inhaling too soon means only 20% of the metered dose reaches one’s lungs. And, if we don’t inhale deeply enough, we lose another 5 or 10% of the dose.

Capmedic metered dose tester
Capmedic Device

 

By the way, Dr. Sabharwal invented the Capmedic sensor that provides such data. (Cognita Labs hopes to sell these to doctors to train their patients properly.) It could help kids, seniors, and those with cognitive impairments get more uniform results. (In the past spacers were used for these folks. But, that still leaves improper shaking and inhaling problems unaddressed.)

This could be a fantastic improvement for those suffering from COPD, asthma, and other respiratory ailments.

Roy A. Ackerman, Ph.D., E.A.

 

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10 thoughts on “Perfect Puff”

  1. When I smoked, I used to use an inhaler (can you imagine anything so stupid as using an inhaler to allow you to smoke?) and no one showed me how to use them. It was the type shown in the video here and from what I remember, I used to press the button, gasp and suck in air. Probably completely ineffective. And as a smoker, it’s not like I didn’t know how to inhale!

    1. Isobel:
      I am shocked (really) how few folks are really shown how to use these devices. Someone just hands you one and expects you to implicitly know what to do.
      I spent time learning how to use one- and taught my kids. My daughter taught her child, too.

  2. Good points. People should be trained to use their inhalers correctly. The training should be done by medical professionals, not by an insert in the box with the expensive inhaler. People can’t be expected to use their (overpriced) inhaler correctly if they don’t have a clue as to how to use it.

    1. Given the price for these things (and the fact that so many folks need the doses), I am hoping everyone starts paying attention-to get the dose they need- and to get what they pay for.
      Thanks for the visit and the comment, Martha.

  3. A really good piece – there’s no point taking medication if you’re not using it correctly – I used to use both an inhaler and have to be hooked up to a massive machine for an hour a day for my asthma. Thank god it was only when I was a kid, but I do remember shaking it before each puff was key 🙂

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