how to use your inhaler

demonstration on how to use your metered dose inhaler and spacer

Here are general instructions for using a metered dose inhaler and spacer.

To begin, shake the inhaler five or six times.

Remove the mouthpiece cover and place the spacer over the mouthpiece at the end of the inhaler.

Put your lips and teeth over the spacer and breathe in slowly. As you do so, squeeze the top of the canister once. Keep inhaling even after you finish the squeeze. Continue inhaling slowly and deeply.

After inhaling, remove the spacer from your mouth and hold your breath for up to 10 seconds.

If you need another dose of medication, repeat the previous steps.

Your inhaler may come with slightly different instructions. Ask your doctor for a demonstration.

How to use dry powder tube inhaler

Here are general instructions for using a dry powder tube inhaler.

To begin, twist the cover off and set it down.

Next, load the dose of medication. Twist the base grip to the right as far as it will go. Twist it back to the left. You will hear a click, which means it's ready to go.

You don't need to shake the inhaler.

Bring the inhaler to your lips in a horizontal position. Put your lips over the tube and take a quick, deep breath. Continue inhaling quickly and deeply.

If you need another dose of medication, repeat the previous steps.

If you accidentally blow into your inhaler after loading a dose, start over and load a new dose. The tube inhaler is designed to deliver one dose at a time.

When you are finished, place the cover back on the inhaler and twist shut. Keep your inhaler dry and store it at room temperature.

Your inhaler may come with slightly different instructions. Ask your doctor for a demonstration.

how to use peak flow meter

A peak flow meter helps monitor respiratory conditions such as asthma, by measuring maximum airflow out of your lungs.

Consult with your doctor as to where to set the color-coded indicators. They are what help determine the status of your airflow.

To begin, hold the meter by the handgrip. Slide the red piston to the bottom of the scale, next to the mouthpiece.

Raise the meter horizontally, inhale deeply, then place your mouth over the mouthpiece and blow forcefully. Make sure your lips act as a seal over the mouthpiece so that no air escapes.

The red piston will slide up the scale. The number that it stops on is your peak flow reading.

Repeat the test two more times. Each time, remember to slide the red indicator back to its start position near the mouthpiece.

Record the highest reading, with the date and time. Your doctor will help determine a personalized scale to use with your meter, dependent on your age, height, sex and health.

how to use dry powder disk inhaler

Here are general instructions for using a dry powder disk inhaler.

To begin, hold the disk level in one hand. With the other hand, put your thumb in the appropriate notch and push it away from you as far as it goes. The mouthpiece will appear and snap into place.

Keep the disk horizontal. Again with your thumb, slide the lever away from you until it clicks.

The disk is now ready to deliver medication.

Put your lips around the mouthpiece. Breathe in quickly and deeply through your mouth — not your nose. After inhaling, remove the disk from your mouth and hold your breath for up to 10 seconds.

To close the disk, put your thumb in the notch and slide it back toward you as far as it goes. The disk will click shut, and the lever will automatically return to its original position. The disk is now ready for your next dose.

Your inhaler may come with slightly different instructions. Ask your doctor for a demonstration.

how to use single dose dry powder inhaler

To begin, remove the inhaler cover. Then hold the base of the inhaler firmly and twist the mouthpiece to open. Push the buttons on each side of the base to test the small spikes within the capsule chamber. These spikes puncture the capsule of medication.

Remove the capsule from its foil container and place it in the capsule chamber at the base of the inhaler. Do not put the capsule in the mouthpiece. Twist the mouthpiece back to a closed position.

With the inhaler upright and vertical, press the spike buttons once. You should hear a click; that's the capsule being pierced.

Release the buttons and prepare to inhale. Do not shake the inhaler.

Bring the inhaler to your lips in a horizontal position. The blue spike buttons should be on the left and right of the inhaler, not top and bottom.

Put your lips over the mouthpiece and breathe in deeply and quickly.

As you inhale, you will experience a sweet taste and hear the capsule spinning in the chamber.

After inhaling, hold your breath for up to 10 seconds.

Open the inhaler to check for leftover powder. If some remains, close the chamber and inhale again.

After use, remove the empty capsule and throw it away. Then close the inhaler and replace the mouthpiece cover.

Your inhaler may come with slightly different instructions. Ask your doctor for a demonstration.

Asthma treatment: Do complementary and alternative approaches work?

Many people try complementary and alternative asthma treatments ranging from herbs to yoga. Discover which home remedies for asthma are most likely to work.

By Mayo Clinic staff

Complementary and alternative asthma treatments range from breathing exercises to herbal remedies. There's limited information about whether most of these treatments really work, but many people try them and claim they help. Here's what the evidence says.

Three promising alternative asthma treatments

More research is still needed to determine just how effective they are, but breathing exercises, yoga and physical exercise are a few of the most promising complementary and alternative asthma treatments.

Breathing exercises
Breathing exercises may improve your quality of life, help reduce asthma symptoms and reduce the amount of medication needed to control your asthma. Two breathing exercises that have been studied include:

• The Buteyko breathing technique. Developed in the 1950s, this method was used to treat asthma in the former Soviet Union. In recent years, it has gained popularity elsewhere. This technique teaches you to habitually breathe less. This prevents breathing too much (hyperventilation). The Buteyko technique also includes advice about relaxation and stress reduction, medication use, nutrition and general health.
• The Papworth method. This sequence of relaxation and breathing techniques involves deep belly breathing (called diaphragmatic breathing), nose breathing and matching your breathing to suit whatever activity you're doing. Some evidence suggests this technique significantly reduces asthma symptoms.

While breathing exercises for asthma are gaining recognition and popularity in the United States, few experts are trained to provide instruction. If you decide to try breathing exercises, you may have to rely on instructional videos or books.

Yoga
This gentle form of exercise has been practiced for thousands of years. There are several types of yoga, but all kinds entail doing a series of stretching poses. In addition to providing the benefits of exercise, yoga also incorporates breathing techniques — called pranayama — which may help reduce asthma symptoms. While more studies are needed to determine how helpful yoga is in treating asthma, doing yoga on a regular basis might help relieve stress — and improve your overall fitness and well-being.

Exercise
You can — and should — keep physically active if you have asthma. Staying active helps control your symptoms and helps you stay healthy. Regular exercise strengthens your lungs so that they don't have to work so hard at breathing. Aim for 30 minutes of physical activity on most days. If you've been inactive, start slowly and gradually increase your activity over time. And, you don't have to do your daily exercise all at once. Doing something that gets your blood pumping and gets you breathing harder for a few short periods — such as 10 or 15 minutes at a time — works too.

Keep in mind that exercising in cold weather may trigger symptoms. If you do exercise in cold temperatures, wear a face mask to warm the air you breathe. And don't exercise in temperatures below zero. Activities such as golf, walking and swimming are less likely to trigger attacks, but be sure to discuss any exercise program with your doctor.

Complementary and alternative medicine

While a number of people try them, evidence is still unclear whether any of the following treatments really work for asthma.

Acupuncture
Acupuncture involves the insertion of thin needles to various depths at strategic points on your body. Acupuncture originated in China thousands of years ago, but over the past two decades its popularity has grown significantly in other parts of the world. While some evidence suggests that asthma symptoms improve with acupuncture treatment, there's still not enough solid evidence to be certain it helps.

Relaxation therapy
Relaxation therapy techniques include meditation, biofeedback, hypnosis and progressive muscle relaxation. Although these techniques seem to reduce stress and promote well-being, it's still unclear exactly what benefits relaxation therapy techniques provide for asthma. Initial research does show that muscle relaxation techniques may improve lung function.

Homeopathy
Homeopathy aims to stimulate the body's self-healing response using very small doses of substances that cause symptoms. In the case of asthma, homeopathic remedies are made from substances that generally trigger an asthmatic reaction, such as pollen or weeds. There's still not enough clear evidence to determine if homeopathy helps treat asthma. The substances that trigger symptoms are used in such minute amounts they are unlikely to cause a reaction. Even so, most asthma experts discourage homeopathic treatment.

Massage and chiropractic treatment
Although some claim that these treatments help, there's no solid evidence that physical manipulation of the spine or muscles, such as massage therapy or chiropractic treatments, helps with asthma symptoms.

Muscle training
This technique helps strengthen the lung muscles with a series of breathing exercises using a special, hand-held breathing apparatus. This type of lung training is sometimes used for other lung diseases such as chronic obstructive pulmonary disease (COPD), and to strengthen the lungs after certain types of surgery. There still isn't sufficient evidence to verify whether this technique helps with asthma.

Herbal remedies
Herbal remedies including butterbur, ginkgo extract and dried ivy have been tried to help with asthma symptoms. But studies are unclear about the benefit of these or other herbal treatments for asthma. Herbal remedies can cause unwanted side effects and interact with prescription medications — and they may not contain consistent doses and may contain harmful substances. Always talk to your doctor before trying any herbal remedy.

Consider the evidence and safety

In most cases, more well-designed studies are needed to make a clear judgment about which CAM therapies for asthma are likely to help. But, keep in mind that lack of solid evidence doesn't necessarily mean these treatments don't work. Although they haven't been rigorously tested in a way that proves they're effective, most haven't been proved ineffective either — they simply haven't been investigated thoroughly enough to make a judgment. While most of these treatments are still not proved, the good news is that it's generally safe to try them along with regular asthma treatment — with the exception of certain herbal supplements, which can be dangerous for some people.

If you do decide to try any complementary or alternative treatment for asthma, be sure to first talk to your doctor about it — and continue your regular treatment. Though some of these treatments may help, when it comes to controlling asthma, alternative treatment is never a substitute for prescribed medications and advice from your doctor.

AS00032

Oct. 4, 2007

Asthma inhalers: Which one's right for you?

Inhalers allow people with asthma to lead active lives without fear of an attack. Here's a rundown of inhaler types, with tips on proper use.

By Mayo Clinic staff

Inhalers have transformed asthma treatment. They enable children and adults with asthma to deliver medicine directly to their lungs nearly anytime and anywhere. A variety of inhalers are available to help relieve or control asthma symptoms.

Types of inhalers

Inhalers are hand-held portable devices that deliver medication directly to the lungs. A variety of inhalers exist, but they basically fall into two categories:

Metered dose inhalers
These inhalers use a chemical propellant to force a measured dose of medication out of the inhaler. They consist of a pressurized canister containing medication, a mouthpiece and a metering valve that dispenses the correct dose of medication. The medication is released either by squeezing the canister or by inhaling. You may find it easier to use a hand-actuated inhaler with a spacer — a short tube that attaches to the inhaler. Using a hand-actuated inhaler to release the medication into the chamber gives you time to inhale more slowly. It decreases the amount of medicine that's deposited on the back of your throat and increases the amount that ultimately reaches your lungs.

Some metered dose inhalers have counters so that you know how many doses remain. If there is no counter, you have to track of the number of doses you've used so that you know when the inhaler is out of medication.

The chemical propellant in metered dose inhalers has traditionally been a chlorofluorocarbon (CFC). But after an international agreement to ban CFCs because they damage the ozone layer, other propellants such as hydrofluoroalkane (HFA) are now used instead. The dose of medication released by an HFA inhaler may feel softer and warmer than the dose released by a CFC inhaler. If you're used to a CFC inhaler, it may not seem like a complete dose — even though the medication is reaching your lungs.

Dry powder inhalers
These inhalers don't use a chemical propellant to push the medication out of the inhaler. Instead, the medication is released by breathing in more quickly than you would with a traditional metered dose inhaler.

Some people find dry powder inhalers easier to use than the conventional pressurized metered dose inhalers because hand-lung coordination isn't required. Some models require operating a cocking device that requires dexterity. Available types include a dry powder tube inhaler, a powder disk inhaler and a single-dose dry powder disk inhaler. Spacers shouldn't be used with dry powder inhalers.

Comparing inhaler types
Choosing the right kind of inhaler for you depends on several factors, such as your hand-breath coordination, your dexterity, whether you can take a deep, fast breath, and what types of medication you need. The chart below can help you understand the pros and cons of each type. Work with your doctor to find the best inhaler for your needs.

Inhaler features

Metered dose inhaler	Metered dose inhaler with a spacer	Dry powder inhaler
Portable and convenient	Less portable and convenient, more complex and more expensive than a metered dose inhaler without a spacer	Portable and convenient
Doesn't require a deep, fast breath	Doesn't require a deep, fast breath	Requires a deep, fast breath
Accidental exhalation before activation won't disrupt medication	Accidental exhalation before activation won't disrupt medication	Accidental exhalation before activation will blow away medication
Hand-actuated models without a spacer require hand-breath coordination	Hand-breath coordination is not critical	Hand-breath coordination is not necessary
Can result in large amounts of medication on the back of your throat and tongue	Less medication settles on the back of your throat and tongue	Can result in large amounts of medication on the back of your throat and tongue
Minimal or no maintenance required	Spacer requires periodic cleaning with soap and water	Minimal or no maintenance required
Some models require you to keep track of how many doses remain	Some models require you to keep track of how many doses remain	It is clear when the device is out of medication
Requires shaking and priming	Requires shaking and priming, correct use of spacer	Single-dose models require loading capsules for each use
Humidity does not affect medication	Humidity does not affect medication	High humidity can cause powdered medication to clump

Medications delivered through inhalers

Inhalers are used to deliver a variety of asthma medications — some that assist with long-term control and others that provide quick relief of symptoms. Some medications may only be available in certain inhaler types. Inhaled asthma medications include:

• Short-acting bronchodilators. These medications, including albuterol (Proventil, Ventolin) and pirbuterol (Maxair), provide immediate relief of asthma symptoms.
• Long-acting bronchodilators. These medications relieve asthma symptoms for longer periods of time. They include salmeterol (Serevent) and formoterol (Foradil).
• Corticosteroids. Used long term to prevent asthma attacks, these medications include beclomethasone dipropionate (Qvar), fluticasone (Flovent), budesonide (Pulmicort), triamcinolone acetonide (Azmacort) and flunisolide (Aerobid).
• Cromolyn or nedocromil. These nonsteroidal medications are used long term to prevent inflammation.
• Corticosteroid plus long-acting bronchodilator. This medication combines a corticosteroid and a long-acting bronchodilator (Advair, Symbicort).

Inhalers may come with slightly different instructions. Follow those instructions carefully and ask your doctor for a demonstration.

The importance of using inhalers properly

It's important that you use your inhaler correctly so that the medication reaches your lungs. Carefully follow the instructions. And ask a doctor, nurse or pharmacist for a demonstration. Use the inhaler in front of this person and ask for feedback. Then practice at home in front of a mirror.

If you're unable to use an inhaler, a nebulizer may be an option. Nebulizers are designed for those who can't use an inhaler, such as infants, young children and those who are seriously ill. The device works by converting medication into a mist and delivering it through a mask that you wear over your nose and mouth.

Using an inhaler is just one part of your asthma treatment plan, which may also include checking your lung function with a peak flow meter, eliminating asthma triggers and exercising. But knowing what types of inhalers are available and how to use them can help you better manage your asthma and get the most from your treatment.

HQ01081

Aug. 17, 2007