Q: My mother is having difficulty using her inhalers. She has rheumatoid arthritis in her hands and struggles to push the metal canister down to spray the dose. Is there anything we can do to make this easier for her? The inhalers she uses are Advair, Atrovent and Ventolin.
The device your mother is using is called a metered dose inhaler (MDI) and it is the device most of us think of when picturing an inhaler. The medication is held in a pressurized metal canister and quickly sprays out through the mouthpiece when the canister is pressed down. A downfall to these devices is they can be difficult to use when someone has decreased movement or strength in their hands.
Your mother’s prescriber can make a few changes to her prescriptions and switch her to a different style of inhaler that will not require her to push so forcefully to spray the dose.
Advair and Ventolin are available as dry powder inhalers called a Diskus. The medication in a Diskus is so finely ground that it may feel and taste like you are inhaling nothing. It is important to drink water after using all dry powder inhalers to prevent the powder from potentially irritating your mouth and throat.
The first step with a Diskus is to slide the plastic cover open to show the mouthpiece. Beside the mouthpiece is a lever that easily slides down until you hear a click which lets you know the dose is ready to be inhaled.
Turn your head away from the inhaler and exhale all the air from your lungs. If you breathe directly into the inhaler the moisture from your breath can clump the powder and clog the inhaler.
Bring the inhaler to your mouth and wrap your lips tightly around the mouthpiece. Breathe in quickly and deeply to pull the medication into your lungs. It does not spray from the inhaler as it does with the MDI device. Try holding your breath for 10 seconds to give time for the medication to be absorbed and then exhale slowly.
If your directions require you to take a second dose, slide the cover back over the mouthpiece and then open it again. Closing the cover will reset the lever so it can be pushed down again to load the next dose.
Ventolin inhalers contain the medication salbutamol, which is a short-acting bronchodilator that works very quickly to relax and open our airways. It is often prescribed to use only when needed to help relieve coughing, wheezing and shortness of breath for up to six hours.
Advair inhalers contain fluticasone propionate which is a corticosteroid that helps to treat and prevent inflammation in the airways and contains salmeterol which is a long-acting bronchodilator that can keep airways open for up to 12 hours. It is used on a regular basis to keep symptoms under control.
Atrovent inhalers contain a short-acting medication called ipratropium that also works to relax and open our airways but in a slightly different way than salbutamol. It is only available in the MDI device, however there is a long-acting medication in the same drug class called tiotropium that is available in other device options. A benefit to switching to the long-acting medication is it’s only used once a day, whereas the Atrovent MDI is often used four times daily.
The easier device for your mother to use would be the Spiriva Respimat as the Spiriva Handihaler would require her to load small capsules into the inhaler before each dose. The first step with a Respimat is to turn the base of the inhaler one half rotation until you hear a click. Exhale all the air from your lungs then open the cap and wrap your lips around the mouthpiece. As you start to slowly breathe in, push the button to release the medication in a slow mist. Continue to breathe in slowly and deeply, then try to hold your breath for 10 seconds and exhale slowly.
This inhaler comes in two pieces that need to be attached before first use. Your mother’s pharmacist will teach her how to assemble and prime the inhaler during consultation. If this part is too difficult for her hands, pharmacy staff can always complete this step for her when she picks up her prescription.
Most community pharmacies have demonstration devices for these inhalers and would be happy to show you how they work and answer any questions you may have prior to changing your prescriptions.
Erin Thompson (BSc, BScPharm) is a graduate of Dalhousie University and a community pharmacist practicing at Shoppers Drug Mart in Quispamsis N.B. Her opinions expressed in this column are published for educational and informational purposes only, and are not intended as a diagnosis, treatment or as a substitute for professional medical advice, diagnosis or treatment.