This confusing situation happens often, even when the
rescue and maintenance inhalers are of
different color. The root problem is lack of standardization
among inhalers, with unclear labeling to distinguish between
rescue and maintenance inhalers. A contributing cause is
lack of proper education for both the caregivers and their patients .
All too often proper instructions were not given
when the drug was first prescribed. And even when they are provided,
patients sometimes don't really understand, or they forget.
Either way, having similar inhalers for different purposes
is an invitation to error. (This was less likely to be a problem
when the drug was studied
by the drug companies; see YELLOW BOX above, under 'DPI Type 2'.)
The problem is compounded when patients are on multiple
inhalers, eg, Proventil for rescue, Advair and Spiriva for
maintenance. That's 3 separate devices with two different
purposes -- easy for the patient to get confused. (Pills and
capsules come in many colors and sizes, but they are all
swallowed the same way.) What's needed is a universal delivery
device for all inhalers, with perhaps just two colors:
red for rescue drugs and green for maintenance drugs.
Anyone with clinical interest in the inhaler problems discussed above
(Errors 1 & 2) should definitely read
Problems With Inhaler Use: A Call for Improved Clinician and Patient Education ,
by James B. Fink and Bruck K. Rubin (Respiratory Care, Sept 2005, Vol 50, No. 10,
3. Not checking some objective measurement of the patient's air flow obstruction.
Every patient should have a breathing test to ascertain the degree of
impairment caused by the asthma. The most frequently performed
test is 'spirometry', which takes just a few minutes and requires the
patient to exhale forcefully thru a testing device (shown below).
A patient performing the spirometry test
Graphs from a normal spirometry test; left panel, graph of flow vs. volume; right panel, graph of time vs. volume.
Nebulisers are machines that turn the liquid form of your short-acting bronchodilator medicines into a fine mist, like an aerosol. You breathe this in with a face mask or a mouthpiece. Nebulisers are no more effective than normal inhalers. However, they are extremely useful in people who are very tired (fatigued) with their breathing, or in people who are very breathless. Nebulisers are used mainly in hospital for severe attacks of asthma when large doses of inhaled medicines are needed. They are used less commonly than in the past, as modern spacer devices are usually just as good as nebulisers for giving large doses of inhaled medicines. You do not need any co-ordination to use a nebuliser - you just breathe in and out, and you will breathe in the medicine.
Comments and suggestions welcome! Email: schumach@
Content Owner: Michael J. Schumacher, MB, FRACP, The University of Arizona