Photo Credit: by @CANPharmaWorld
According to Asthma and Allergy Foundation of America, as many as 25 million people in the American population have asthma. This comprises about 8% of adults and 7% of children in America. It's estimated that 16 million people in the U.S. suffer from chronic obstructive pulmonary disease (COPD). A category of people have both asthma and COPD. Asthma and COPD are respiratory diseases that require using inhalers to breath easier. In this article, you'll learn about the different types of inhalers used to manage asthma and COPD, and how to get the most benefits from your inhalers.
Asthma causes spasms in the airway due to exposure to allergens and occurs in bouts of attacks characterized by chest tightness, cough and wheezing. However, COPD causes a more persistent and progressive respiratory symptoms such as difficulty breathing, cough and or phlegm production. The lungs and airways in COPD patients are usually inflamed and narrowed and the muscles lose their ability to relax properly. COPD is common in long-term smokers. Other important risk factors for COPD include environmental exposure to smoke, indoor air pollution, and occupational dusts, fumes, and chemicals.
Here are 5 facts you need to know about your inhalers:
1) Asthma vs COPD inhalers: many people wonder what are the differences between asthma and COPD? Although the symptoms of asthma and COPD are similar, the underlying causes are different. Asthma is typically diagnosed earlier in life, while COPD occurs much later in adulthood. COPD is mainly due to damage caused by smoking, while asthma is due to an inflammatory reaction. The risk of developing COPD then becomes slightly higher in asthma patients especially in patients that smoke. Since the underlying causes are different for the 2 diseases, their respective inhalers are also different.
The main goal of asthma and COPD inhalers is to open the air passages to improve air flow. The inhaler devices may be similar but the ingredients in the devices may differ. Based on how they act, asthma and COPD medications can be grouped as follows: Relievers: which opens the airways to relieve cough and shortness of breath. Controllers inhalers: long acting bronchodilators, long acting antimuscarinics, steroid anti-inflammatory, and combinations. Relievers such as Proair, Ventolin, Symbicort can be used for both asthma and COPD. Steroidal anti-inflammatory inhalers (QVAR, Flovent, Advair) are more commonly used in asthma cases, while long acting bronchodilators, anti-muscarinic (Atrovent, Incruse Ellipta), and combinations (Anoro ellipta) are usually reserved for COPD cases.
2) Know different types of inhalers. You should always carry your inhalers with you to make it accessible for use when needed and at scheduled times. Your doctor may prescribe more than one inhaler for you therefore it is important for you to know the right precautions for each inhaler to get the most benefit from them.
Metered dose inhaler: a metered dose inhaler (MDI), which is the most common type of inhalers, is designed to deliver an exact amount of medication in a fine mist that can be breathed directly into the airways. An MDI is a portable, compact, multidose device that is usually less expensive than other devices. Most asthma and COPD medications are available as MDI. However, dose counters are not available, it needs to be shaken properly before using each time and primed when not used for a specified period. Common errors with the use of MDI’s include inhaling too fast, failure to empty lungs prior to inhalation, failure to hold breath after inhalation.
Dry powder inhaler: Dry powder inhalers (DPI) are also compact and portable devices that deliver fine powder of medication. Dry powder inhalers require less coordination since they are actuated by breathing in. However, a first step of dose loading is usually required. If using a single dose device such as Spiriva, the capsule needs to be loaded in the device and actuated before ready for inhalation. Multiple dose DPI include: Diskus, Ellipta, Turbuhaler. Doses need to be loaded before inhalation by either pressing a lever, opening a cap or twisting the cap. DPI’s are breath activated, therefore, need to inhale deeply and forcefully to get the full dose at once. Because the dry powder for inhalation is so fine, you may not feel anything in your mouth or throat after inhalation. Care needs to be taken to store DPI’s inhalers away from heat and moisture.
Soft mist inhaler: An example of soft mist inhaler (SMI) device is a Respimat e.g. Combivent Respimat, Spiriva Respimat. Respimat is slightly bigger than regular MDI but its also easy to use. SMI usually come in multidose devices that require less coordination to use compared with other devices. Therefore, a Respimat may be more suitable for use in children and older adults. Dose needs to be loaded into the device in form of a cartridge. A respimat needs to be primed if not used for more than 21 days.
3) Understand the difference between reliever and controller medications: Relievers are short acting bronchodilators (Ventolin, Proair) or a combination of steroid and intermediate bronchodilators (Symbicort) that help to open your airways in case of shortness of breath or incessant cough. You need to carry your reliever inhalers around with you at all time to make sure it is available for use in case of emergency. Controller inhalers are those you need to use on a regular basis to control your symptoms in the long term.
4) Understand the Importance of using your controller inhalers regularly: You need to use these inhalers regularly as scheduled by your doctors regardless of how you feel. For example, using your steroid inhaler regularly will keep inflammation down in your airways and therefore prevent acute attacks of asthma. It is estimated that more than half of inhaler users do not use their inhalers correctly. Errors in inhaler techniques and poor adherence leads to poor control of asthma and COPD. Ensure you are using proper inhaler techniques.
5) Follow your action plan when your inhalers seem not to be working: most asthma patients have an action plan pre-designed with your doctor. If after using your inhalers properly and regularly your symptoms are still not properly controlled, it is important to follow up with your doctor. Do not ignore flare ups and know when your asthma is out of control. A short course of oral corticosteroids may be needed. Talk to your doctor.
Apart from knowing your inhalers and using them correctly, it is important to quit smoking, stay up to date in your immunizations, engage in adequate physical activity, and manage other co-existing conditions.
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