For the majority of the 5.4 million people with asthma in the UK, inhaled medications are the mainstay of asthma management, providing targeted and effective treatment that can prevent and treat potentially life-threatening asthma attacks.
Good inhaler technique is vital to ensure that people with asthma are getting the most out of their preventer and emergency reliever medication. But as nurses we often see patients who struggle to use their inhalers properly, meaning the medicine doesn’t reach their lungs where it is needed.
Recent research has shown that almost half of people with asthma are not using their inhaler properly, leaving them at an increased risk of an asthma attack.
Poor inhaler technique can result in reduced or no inhaled medicine getting into your patient’s lungs, where it is needed to reduce asthma symptoms such as coughing, wheezing or a tight chest. This in turn means that more medicine stays in your patient’s mouth or throat, which can lead to side effects such as a sore throat or oral thrush.
“There are common mistakes that patients can make when using an inhaler, but many of these can be corrected with small tweaks”
Poor inhaler technique with reliever inhalers can also increase the amount of medicine absorbed into the bloodstream, which could lead to side effects such as shakiness, headaches and an increased heart rate.
So, what can we do to support our patients with asthma on how to use their inhaler correctly?
The most important thing we can do is make sure that our patients are booked in and attending their yearly asthma review, where we can check their inhaler technique to make sure they haven’t slipped into bad habits and advise them on how it can be improved.
There are common mistakes that patients can make when using an inhaler, but many of these can be corrected with small tweaks. Errors include patients breathing in too forcefully or not forcefully enough, not breathing in deeply enough, or not preparing their inhaler properly before use, such as shaking the device. We can also suggest the use of spacers where appropriate as these can make a huge difference to the amount of medicine getting to the lungs.
But there are also challenges for nurses who need to demonstrate to patients how to use their inhalers. While there are two main types of inhaler – dry powder inhalers (DPIs) and pressurised metered dose inhalers (MDIs) – within each group there are many different types of device which need to be taken in different ways.
Research shows that this can be problematic, with around 93% of health professionals not being able to fully demonstrate how to use asthma inhalers. We also only have a very short amount of time with our patients each year, so finding the time to assess inhaler technique can also be difficult.
And even when we check our patients’ inhaler technique at their annual review, how can we be sure they are remembering our instructions correctly for the rest of the year, when they are managing their asthma themselves.
Asthma UK has provided a teaching aid in the form of 21 easy-to-follow instructional videos that show how to use many of the different types of inhalers, spacers and nasal sprays. They’ve been endorsed by the UK Inhaler Group, a not-for-profit coalition of organisations and individuals from highly respected bodies, making the information accurate and of the highest standard.
This up-to-date video library can be used by nurses and other health professionals for free to help explain technique to patients, and patients can be directed to the videos before, during, or after their annual asthma review.
“It’s crucial that nurses feel confident in explaining inhaler techniques and that people with asthma know how to use their inhaler correctly”
This means people with asthma can also access them freely on their mobile phones, helping them to further improve their inhaler technique when they are outside of a clinical setting, whether at home or on the go.
It’s crucial that nurses feel confident in explaining inhaler techniques and that people with asthma know how to use their inhaler correctly.
By making sure our patients are equipped with the best knowledge and tools to manage their asthma, we can help to reduce the risk of them having a potentially life-threatening asthma attack.
For more information and to access Asthma UK’s inhaler videos, visit www.asthma.org.uk/inhalervideos
Caroline Fredericks is asthma nurse specialist at Asthma UK