The correct way to use inhaler for patients with asthma

Some of the acute and dangerous symptoms of asthma can be controlled using inhalers, but what is very important and vital is the correct time and method of using inhalers!
When asthma symptoms and attacks occur, the drugs in inhaler devices can be very vital in relieving a person of wheezing, coughing and shortness of breath! For a person with asthma, inhaler spray is one of the main things that he should have in his bag when he leaves the house! It is worth mentioning that, in addition to asthma, inhalers are also used for chronic obstructive pulmonary disease (COPD).
But what is certain is that in order to maximize the benefits of inhaler drugs and their effect on the recovery and control of asthma symptoms, one must be well aware of the correct time and method of using inhaler devices!
If inhaler devices are used correctly, appropriate and effective amounts of medicine will reach the patient’s lungs, and in this way, with a local and rapid effect, they will control the acute symptoms in the person.
Also, as a result of the correct use of drugs in inhaler devices, the need for oral and injectable drugs (which have more adverse side effects) may be reduced.
Unfortunately, despite the favorable effects of inhalers, evidence shows that many patients cannot use inhalers properly! It is estimated that about 90% of patients do not use inhalers with adjustable medicine amounts (Metered Dose Inhalers MDIs) or 54% of inhalers containing powder (Dry Powder Inhalers DPIs) in the correct way!
Lack of knowledge of the correct way to use inhaler devices reduces the amount of medicine that enters the patient’s lungs and increases the wastage of medicine.
Obviously, this will cause the lack of control of the disease, increase the probability of asthma attacks and visits to the emergency departments of hospitals, reduce the quality of life and also spend higher costs for treatment. In addition, improper use of inhalation devices may cause the medicine to remain in the back of the throat, tongue or in the mouth, which may cause side effects such as oral thrush or sore throat.

In general, to control and improve the symptoms of asthma, there are often two main types of inhalers available:
Aerosol inhalers
, usually these devices either contain medicinal solutions or have a suspension of solid particles inside them. It is a gas.
In this type of inhalation devices, the drug is sent into the respiratory tract and lungs (during a gentle breath) with the force created by the device itself.
Among the types of aerosol inhalers, we can mention the inhaler with adjustable drug amount or MDI.

DPI inhalers (containing dry powder)
DPI inhalers turn the medicine into respirable powder particles.
In DPI inhalation devices, unlike MDI devices, it is possible to send medicine into the respiratory tract and lungs with a deep breath of the patient!

Ensuring effective inhalation and drug delivery to the target site depends on many factors that ultimately affect the patient’s response to treatment. To choose an inhaler, the patient should not only consider the aspects related to the device (for example, the speed of the aerosol particles), but also the individual factors of the patient (such as the breathing process, skill and familiarity with using the device). In all types of inhalation devices, the error rate increases with age and the severity of airway obstruction. Regardless of the type of device prescribed, unfortunately, incorrect use of inhalation devices is common. 
Pay attention to these tips when using inhalation devices

1. Aerosol inhalation devices such as MDI types should be shaken well before use.
   This should be followed for almost all inhalers, although DPIs do not need to be shaken before use.
2. In order to use an aerosol inhalation device such as MDI for the first time (in order to check the performance of the spray), it must be prepared. Also, if these devices are not used for a period of 5 to 7 days, they need to be prepared again.
3. Before using the inhalation spray, the air inside the lungs should be removed. Complete exhalation reduces the amount of air in the airways and increases the space available for air in the next breath. As a result, breathing is deeper and the possibility of carrying medicine to the lungs increases.
4. Patients should be trained not to hold down the opening of the DPI (dry powder) inhaler during use or after preparation, because the medicine may come out of the device. The device should be placed horizontally or vertically.
5. When using the inhaler, the patient should keep his chin up or his head slightly elevated. The device must be properly placed in the mouth and the lips must be firmly placed on the outlet of the device.
6. The patient must coordinate his breathing with the release of the drug from the MDI inhalation spray.
7. It should be noted that in case of using easy breathing device or demiyar, the medicine will be suspended for a short period of time, so the patient should inhale the medicine without any delay immediately after placing the medicine in the easy breathing chamber. Otherwise, some of the medicine will be deposited on the inner surface of the easy-to-breathe chamber and will be lost.
8. To use inhalation devices, the intensity and speed of breathing should not be too fast or too slow. It should not be forgotten that the complete placement of inhaled medicine in the lower respiratory tract and lungs is influenced by the speed of inhalation!
   In aerosol inhalation devices such as MDI, slow and steady inhalation increases the drug’s entry into the lungs. When the patient inhales, the drug particles travel the same path as the airflow to reach the lung until a change in their path occurs.
   Contrary to imagination, inhaling very quickly not only does not increase the drug’s entry into the lungs, but also increases the contraction and blockage of some points along the drug’s path, such as the throat and the main lung ducts. Therefore, the drug is prevented from continuing its journey in these places and gets deposited.
9. Unlike aerosol devices (such as MDI), in devices containing dry powder such as DPI devices, rapid and deep inhalation should be performed. This is to create a great force in order to prepare and optimize the size of the particles and their placement in the lungs. Therefore, inhalation should be strong from the beginning. If you do not inhale deeply and strongly, the possibility of drug deposition in the mouth and throat increases!
10. Holding the breath after inhaling the medicine increases the durability of the medicine in the lungs. By holding the air for a few seconds, the effect of the drug in the lungs will increase significantly!
11. If it is necessary to use the device several times in a row, there should be a gap of a few seconds between the times of use. Fast use of the device reduces the amount of medicine delivered in each session.
12. Often, empty inhalers, especially devices that release aerosol particles, are not detected.
13. Every 6 to 12 months, Asan Nafs or Demiyar device should be checked in terms of the cleanliness of the outer cover, the health of the body (cracks) and the operation of the device.
14. If you need to use more than one type of inhaler, you should leave at least 5 minutes between using the next device!
15. Keep inhalers at the right temperature. Extreme temperatures or high altitude can affect the medicine in the device. The patient should read the instructions for maintaining his inhaler.
16. Do not use water to clean the inhaler containing dry powder because the powder is sensitive to moisture.