Inhaler therapy is a method that allows medication to reach the lungs directly in respiratory diseases such as asthma and COPD. It acts within seconds during shortness of breath crises. In fact, thanks to the use of inhaler therapy, you achieve high efficacy even with very low doses. In this article, you will find answers to questions such as what inhaler therapy is, in which situations it is used, and what the steps for using inhaler therapy are. We will also discuss acute bronchitis inhaler therapy and COPD inhaler therapy applications in detail.
What is Inhaler Therapy?
Definition of inhaler therapy
An inhaler is a portable device that allows medications to be delivered directly to the respiratory tract in the form of an aerosol or powder particles. It uses pressurized spray or breath-actuated systems. Known colloquially as "breath-opening sprays," these devices not only open narrowed bronchi but also deliver protective medications that control inflammation in the airways to the lungs.
The medication inside the device travels into the respiratory tract as you inhale. It contributes to opening the bronchi, reducing wheezing, and relieving the feeling of tightness in the chest. It is an indispensable treatment tool, especially in chronic respiratory diseases such as asthma and COPD.
Working principle of inhaler therapy
For medication particles to be effective in the lungs, they must be smaller than 5 microns. Particles of this size reach the distal airways and exert a therapeutic effect. The rate of drug deposition in the lungs varies between 1-50% depending on the device type and technique used. The remaining portion accumulates in the oral cavity or is exhaled.
The correct breathing technique plays a critical role in ensuring the medication reaches the target area. Incorrect technique significantly reduces the effectiveness of the medication. Particle size and density are determining factors in drug deposition in the lungs. The hygroscopic property of drug molecules also affects particle size.
Differences between inhaler therapy and other treatment methods
Inhaler therapies offer distinct advantages compared to oral pills or injections. By delivering the medication directly to the target organ, the lungs, the same therapeutic effect is achieved with very low doses in the microgram range. In essence, 15-20 times higher doses are required to achieve the same effect via the oral route.
The serum drug level formed during inhaler use is 100 times lower than in the oral form. Since the medication does not spread throughout the entire body, systemic side effects such as stomach problems and palpitations are seen much less frequently. On the other hand, the risk of stomach discomfort and systemic side effects is high with oral medications.
Inhaler therapy is painless and easy to apply. Its effect starts quickly, providing relief within seconds, especially during shortness of breath crises. Because its metabolism in the bronchial mucosa is slow, the effect of the medication lasts longer. It provides maximal bronchodilation as it reaches the bronchial smooth muscles in high concentrations. The fact that the devices are small and lightweight allows patients to carry them easily everywhere.
In Which Situations Is Inhaler Therapy Applied?
The use of inhalers in the treatment of respiratory diseases is preferred in many different situations. Although each disease has its own unique treatment approach, delivering the medication directly to the bronchi is a common goal.
Inhaler therapy in asthma
Asthma is a chronic disease that causes narrowing in the airways within the lungs due to non-microbial inflammation. It manifests with symptoms such as recurrent shortness of breath, wheezing, chest tightness, and coughing.
Most asthma medications are used via inhalation. Since the airways are affected, the medication must be delivered directly to the site of the disease. Low-dose usage means far fewer side effects.
Poor medication adherence in asthma patients is associated with an inability to control the disease and frequent exacerbations. Treatment non-adherence is higher than in many other chronic diseases. There is a very clear relationship between incorrect inhaler technique, poor disease control, and increased exacerbations.
COPD inhaler therapy
In COPD treatment, bronchodilators are central to symptom management. Short-acting beta-2-agonists (SABA) or short-acting antimuscarinics (SAMA) are usually the first choice. They facilitate breathing by relaxing and widening the small airways. You use them up to four times a day when you feel shortness of breath.
If you still have daily symptoms despite using your SABA or SAMA inhaler correctly, long-acting beta-2-agonists (LABA) and long-acting antimuscarinics (LAMA) are used. Because their bronchodilation effects last longer, you only need to use them once or twice a day.
If necessary, an inhaled corticosteroid (ICS) can be added to your long-acting bronchodilator inhaler to help reduce inflammation in your airways.
Acute bronchitis inhaler therapy
Acute bronchitis is a short-term respiratory infection that occurs as a result of inflammation of the bronchi and usually lasts for a few weeks. It manifests with symptoms such as coughing, phlegm, and shortness of breath.
For bronchitis with suspected bronchospasm, you can treat the cough using inhaled bronchodilators. Patients with wheezing may benefit from the use of inhaled beta2-agonists for a few days. Medications that dilate the bronchi can be used in patients experiencing shortness of breath.
Cystic fibrosis and other respiratory diseases
A significant portion of medications in the treatment of cystic fibrosis is administered via the respiratory route. The most commonly used inhaled medications are bronchodilators (salbutamol), inhaled antibiotics (tobramycin, colistin), and treatments that help break down and clear mucus (dornase alfa, hypertonic saline, mannitol).
They are used for the purpose of correcting respiratory obstruction, regulating mucus clearance, and reducing the microbial load of the bronchial tree. Nebulizers turn liquid medication into fine particles and ensure they reach the respiratory tract with the help of a mask or mouthpiece.
Inhaler Types and Features
Different device systems have been developed to deliver respiratory medications to the lungs. Each has its own unique working mechanism and usage features.
Metered-dose inhalers
Metered-dose inhalers are devices that contain medication in liquid form with the help of pressurized gas and release a specific dose of aerosol with each press. The medication inside the metal canister is ejected at high speed thanks to the propellant gas. You need to synchronize the activation of the device with the moment of inhalation seamlessly.
Thanks to their small and portable structure, they are easily used in daily life. They contain multiple doses and can be applied quickly. However, the requirement for hand-breath coordination is their biggest disadvantage. To solve this problem, intermediate parts known as chambers or spacers can be used. The use of a spacer reduces oropharyngeal drug deposition and dose loss.
Dry powder inhalers
Dry powder inhalers do not contain propellant gas and store the medication in a very fine powder form. The working mechanism of the devices relies entirely on your own breathing power. When you take a deep and strong breath, the powder capsule or reservoir inside the device is activated.
They are divided into two main groups. The first group consists of single-dose devices that work by inserting and piercing a gelatin capsule containing the medication. Aerolizer and Handihaler are examples of this group. The second group consists of multi-dose devices containing medication in the form of a reservoir or foil strip. Diskus and Turbuhaler fall into this category.
They are easier to use as they do not require hand-breath coordination. They usually have dose counters. However, the patient must still have sufficient breathing power.
Inhaler therapy with a nebulizer
Nebulizers are electrical devices that turn liquid medication into a continuous mist with the help of a compressor or ultrasonic waves. Patients inhale this mist by breathing normally through a mask or mouthpiece.
Three different types are available. Jet nebulizers turn liquid medication into mist with air pressure. It is the most commonly used type but operates noisily. Ultrasonic nebulizers use high-frequency sound waves and are quieter than jet nebulizers. Vibrating mesh nebulizers turn the medication into mist with a vibrating membrane. They are portable and quiet.
Nebulizers can be the first choice in many diseases such as asthma, obstructive lung disease, pneumonia, cystic fibrosis, bronchiolitis, bronchospasm, and croup. They provide rapid effect, have few side effects, and require less coordination than other inhaler therapy methods.
Which inhaler type is right for you?
Choosing the right device depends on the patient's age, physical, and mental ability. A metered-dose inhaler may not be a good choice for a patient who cannot perform hand-breath coordination. Dry powder inhalers are not suitable for patients who cannot provide sufficient breathing power.
If breathing power is insufficient, a nebulizer can be preferred. The ease of use of the device, its portability, and its acceptability by patients are absolutely necessary.
Steps for Using Inhaler Therapy
Correct steps for using inhaler therapy ensure the effectiveness of the medication. Incorrect technique is the most important cause of treatment failure. How you use the device should be practically observed by healthcare personnel, and deficiencies should be corrected.
Preparation steps before use
It is important to get to know the device before the first use. Remove the cap and make sure the mouthpiece is clean. Shake the device for 5-10 seconds to ensure the medication is evenly distributed. If you are using it for the first time, perform a test spray by releasing one dose into the air. Check the expiration date of the medication.
Sit in an upright position or stand. Keep your head upright and tilt it slightly back. The device should be at the same level as the mouth area.
Inhaling the medication correctly
Take a deep breath and exhale completely. The air in the lungs should be emptied. Be careful not to exhale into the device. Grip the mouthpiece firmly with your lips. Close it so that no air leaks.
For metered-dose inhalers, press the device from the top simultaneously while taking a deep and slow breath. For dry powder inhalers, draw the medication into the lungs by taking a fast and deep breath. Hold your breath for 10 seconds to allow the medication to reach the lungs. Then, exhale slowly through your nose.
If a second dose is required, wait at least 30 seconds. Shake the device again and repeat the same process.
Things to do after use
If you used medication containing corticosteroids, gargle your mouth with water and spit the water out. This prevents fungal infection and hoarseness in the mouth. Close the cap of the device.
For daily maintenance, wipe the mouthpiece with a dry cloth. For weekly cleaning, wash the mouthpiece with warm water and let it dry thoroughly. Keep away from humid environments.
Inhaler use in children
Children should use inhalers with a spacer and mask. Fit the mask completely to the face. The nose and mouth should be completely covered. Sit the child in an upright position. Spray the inhaler into the air and ensure they take at least 5-6 breaths. Teaching through play makes the process easier.
Inhaler use in adults
The most common mistake in adults is a lack of coordination. Using a spacer solves this problem. If manual dexterity is reduced, an intermediate part is recommended. You can set alarms to remind you to take the medication. Regular physician check-ups should not be neglected.
Benefits of Inhaler Therapy and Points to Consider
Rapid effect and low side effect profile
Inhaler therapies are an effective method with a very low risk of systemic side effects. Since the medication reaches the respiratory tract directly, symptoms are relieved quickly. This speed is of vital importance, especially in asthma and COPD crises.
Because medication is sent directly to the lungs, systemic side effects are minimal. Since it mixes into the blood in very small amounts, side effects such as stomach problems and palpitations are rarely seen. It offers a much safer profile compared to pills or injections. Because its metabolism in the bronchial mucosa is slow, the effect of the medication lasts longer. It provides maximum bronchial dilation and is a painless application.
Common mistakes made in inhaler use
Using an inhaler with incorrect technique leads to insufficient medication being delivered to the lungs. Most patients make some mistakes without realizing it. At least half of the patients using inhaler devices in our country use their devices incorrectly.
The most common mistakes are:
Not shaking the inhaler: Always shake liquid medication before each use. Application without shaking reduces the total dose to be inhaled by 25-35%.
Breathing too fast or too slow: Draw the medication into the lungs with a slow and deep breath. The wrong breathing speed affects the deposition of the medication in the lungs.
Exhaling immediately: Wait at least 10 seconds after inhaling the medication. Exhaling immediately leads to the medication being expelled.
Not paying attention to mouth hygiene: Rinse your mouth with water after use. In medications containing corticosteroids, this step prevents fungal infection.
Exhaling into the device: This causes the drug powder to become damp and its effectiveness to decrease.
Incorrect technique leads to the deterioration of disease control and an increase in exacerbations. Therefore, you must ensure that you use the device with the correct technique.
Device maintenance and hygiene rules
Regular maintenance of your inhaler device directly affects treatment success. Wipe the mouthpiece with a dry tissue after each use. Check if there is any medication residue inside the device.
Perform a deep cleaning at least once a week. Wash the parts with warm water but do not use soap or detergent. You can use warm water and mild soap for spacer devices. Rinse thoroughly so that no soap residue remains. Instead of wiping with a cloth, allow it to air dry on its own. Cloths can carry bacteria and transmit them to the device.
Store the device in a cool and dry place. The cleaning frequency should be at least once a week. Reassemble after ensuring it is completely dry.
Frequently Asked Questions
Patients ask many questions about inhaler therapy. We have answered the curious topics from daily use to travel, from side effects to storage conditions.
When should I use the inhaler? Use it regularly at the times recommended by your doctor. Crisis-preventing medications are taken at specific times in the morning and evening. Medications used during a crisis are used as needed when you feel shortness of breath. It does not matter if it is used before or after meals.
How should I store the inhaler? Store it in a dry place at room temperature. Keep away from sunlight and moisture. Do not store it in the bathroom because moisture damages the device. Keep it out of the reach of children. Do not put it in the refrigerator.
What should I pay attention to when traveling? Always carry your inhaler in your handbag. It may get lost in the suitcase, or if the luggage is lost during air travel, you will be left without medication. Also, do not neglect to take a spare inhaler. Do not leave it in a hot vehicle for a long time.
Is inhaler therapy safe during pregnancy? Inhaler therapies are generally safe during pregnancy. However, be sure to consult your doctor. Uncontrolled asthma can harm the baby. Therefore, it is important to continue treatment regularly. Most inhalers can also be used safely during breastfeeding.
When should I change the inhaler? Obtain a new inhaler when the dose counter approaches zero. Follow the number of remaining doses in metered-dose inhalers. Replace the device if it is damaged or if the mouthpiece is broken. Do not use medications that have passed their expiration date.
What should I do if I forget a dose? Use it as soon as you remember. On the other hand, if the time for the next dose is near, do not take the dose you missed. Do not try to compensate by using a double dose. You can set a phone reminder for regular use.
Is inhaler therapy expensive? Some of the prescription inhaler medications are covered by social security. You can obtain them from the pharmacy with a hospital prescription. In some cases, you may have to pay a co-payment. For example, some new-generation inhalers may be more costly.
Can I use it with my other medications? Inhaler therapies are used safely with most medications. However, inform your doctor when you start a new medication. Those using heart medications should be especially careful. Even herbal products can interact.
In Summary, Inhaler Therapy
Inhaler therapy is one of the most effective methods in respiratory diseases such as asthma and COPD. Because it carries medication directly to the lungs, you get fast results even at low doses. On the other hand, incorrect usage technique significantly reduces treatment success. Learn to use your device correctly, clean it regularly, and continue to use it as recommended by your doctor. Remember that when your inhaler is used correctly, it will improve your quality of life, reduce shortness of breath crises, and help you keep your disease under control.
