Lessons on pulmonary inhalers

My younger brother had asthma since he was 5 years old. During his asthmatic attacks, he wheezes, grabs his chest frantically searching for air, his shoulders become tense, he is hunched over as he reaches for the nearest inhaler, takes one puff and immediately his shoulder loosens up and he is calm again. It amazes me what medicine can do.

Two days ago, we were trained on the proper use of pulmonary inhalers for asthma and other COPDs (chronic obstructive pulmonary disease). After a three hour training session over a course of 2 days, our class of 123 was divided into small groups of 3-4 students and assigned various preceptors who would train and ultimately test our knowledge of the use of inhalers. Several of us dreaded that we had to return after a long day but at the end of the session, we were impressed at our knowledge of the use of various inhalers. I was fortunate that my preceptor was Dr. Ron Finley. He shared several personal stories during the course of his career and that made me realize how imperative it is for pharmacists to monitor and assess patients use of inhalers.

One story involved a patient swallowing a dime because he did not check the mouth piece of his inhaler. Usually debris becomes deposited and occludes the way for proper delivery of medicine to the lungs. consequently, patients complain their inhaler isn't effective so the doctor increases the dose, unnecessarily.

LESSON: Always check the mouthpiece of your inhaler for debris and dimes.

Another story involved an elderly lady who entered the hospital because of a respiratory attack. When asked to demonstrate her use of the inhaler she remarks that she's been using the inhaler for decades and knows how to use it correctly. Nevertheless, she reluctantly demonstrates her technique and sprays the inhaler 2 feet away and tries to capture the mist in the air.

LESSON: Periodically have patients demonstrate how they use their inhaler because improper use may compromise the effectiveness of their medicine.

Patient comes in and complains that the medicine leaves a bitter residue on the tongue. So this warns you that the patient may not be compliant and may not be taking their doses.

LESSON: Have the doctor prescribe a spacer which decreases the chances of side effects because less particles become stuck in the mouth and delivers medicine effectively to the lungs.

Ultimately, the goal of a pharmacists is to help patients breathe better.