Using an Inhaler and Nebulizer Introduction An inhaler is a handheld device that is used to deliver medication directly to your airways. A nebulizer is an electric or battery powered machine that turns a liquid into a breathable mist. The mist is inhaled into the lungs. Inhalers and nebulizers are commonly used to treat asthma, chronic obstructive pulmonary disease and other lung diseases. Whether you use an inhaler or a nebulizer or you care for someone who does, it is important to know how to use an inhaler correctly. This reference summary explains inhalers and nebulizers and how to use them. The Lungs and Respiratory Problems The lungs are part of the respiratory system. The respiratory system is made up of the organs that are involved in breathing. This section reviews the anatomy of the lungs to help you better understand the function of nebulizers and inhalers. Lung Trachea Oxygen is vital for life. Without it, death happens very quickly. The lungs allow us to fill our blood with oxygen. The air we breathe comes in close contact with blood in the depth of the lungs. The blood then fills up with oxygen and releases unwanted carbon dioxide, or CO2. 1
When we breathe, the air goes through the mouth and nose. From there it goes to the air pipe, known as the trachea. From the trachea, it goes into an increasing number of smaller tubes. These are known as bronchial tubes. Small balloon like sacs called alveoli are at the end of the tubes. The walls of the alveoli are very thin. On the other side of the walls there are small blood vessels. These thin walls allow oxygen to go into the bloodstream. They also allow CO2 to go from the blood to your lungs to be exhaled. People with respiratory problems have trouble breathing. They may be sensitive to certain materials. These materials are called triggers because they trigger symptoms. Coming into contact with a trigger may cause inflammation or swelling of the inner lining of the lungs. This swelling can cause narrowing of the air passages. Triggers can be allergens or irritants. Allergens are substances that trigger an allergic reaction from the immune system. Pollen is an example of an allergen. Irritants are things that injure the cells directly, like cold air, cigarette smoke, perfume or gasoline. Swelling and inflammation of the inner lining of the lungs can lead to difficulty breathing and tightness in the chest. The muscles around the bronchial tubes could also tighten abnormally. This can result in further narrowing of the air passages. Some people have chronic breathing problems, which are long-term or ongoing. Common chronic breathing problems include: Allergies. Asthma. Chronic obstructive pulmonary disease (COPD) or emphysema. Sinusitis. Chronic obstructive pulmonary disease is a type of lung disease. It causes permanent damage to tissue in the lungs, making it hard to breathe. It develops over many years and is usually caused by cigarette smoking. 2
Chronic breathing problems can cause a range of symptoms, including: Chest congestion. Cough. Labored breathing. Shallow breathing. Wheezing. To treat chronic breathing problems, health care providers often prescribe the use of an inhaler or nebulizer. These devices deliver medicine directly to the airway. Nebulizers and inhalers work equally well when they are used correctly. You should work with your health care provider to decide which type of device best suits your needs. The decision will be based on your age, your abilities and the type of medication that you need. You may try several different devices before finding the right one. The following sections explain how to use inhalers and nebulizers. Inhalers An inhaler is a handheld device. It delivers medication directly into your airways. Inhalers are commonly used to treat problems that affect your ability to breathe. Your health care provider may recommend that you use an inhaler if you have: Asthma. Chronic obstructive pulmonary disease. Other ongoing respiratory problems. The asthma medications delivered by the inhalers include: Bronchodilators. Steroids. Combination of bronchodilators and steroids. Bronchodilators cause small airways in the lungs to open up. Steroids are used to relieve swelling and inflammation. 3
Some inhalers are meant for limited use during an emergency situation. Others are used daily to prevent breathing problems. Using the right amount of medication is important in the treatment and prevention of ongoing respiratory problems. Medications can also decrease the sensitivity of the lungs to allergens. Inhalers are commonly used to deliver these medications directly into the airways. Inhaled medicine relieves symptoms faster than the same medicine given in pill form. Fewer side effects happen when medicine is delivered by an inhaler instead of taken in pill form. That s because medicine from an inhaler goes directly into the airways. Very little medicine ends up in the bloodstream. Inhalers come in many different forms. The most commonly used inhalers are: Metered dose inhalers. Metered dose inhalers with a spacer. Dry powder inhalers. A metered dose inhaler, or MDI, is a small aerosol canister that holds medicine. A mouthpiece is attached to the canister. The Metered Dose Inhaler inhaler is small enough to fit inside a pocket. Some MDIs release the medicine when you push the canister into the mouth piece. Other MDIs release it when you inhale. A metered dose inhaler with a spacer is similar to a regular MDI. The main difference is that it holds the medicine in a special compartment, called a spacer, after it is released. An inhaler with a spacer is larger than a regular MDI. A spacer makes it easier to inhale the medicine more slowly. Inhaling slowly increases the amount of Metered Dose Inhaler with Spacer medicine that reaches your lungs. It prevents medicine from sticking to the back of your throat. Some MDIs come with a built-in spacer. Others require you to attach the spacer yourself. 4
A dry powder inhaler, or DPI, does not use aerosol to push the medicine. Instead, you get the medicine by taking a fast, deep breath. DPIs are either shaped like a tube or disk. They may have a removable cap or cover. They may contain multiple doses of medication or a single dose. The following sections provide general instructions for using each type of inhaler. Your health care provider may also give you instructions. Using a Metered Dose Inhaler A metered dose inhaler usually has 3 parts: A tube-shaped canister of medicine. A mouth piece. A cap that covers the mouthpiece. Dry Powder Inhaler To prepare the inhaler: 1. Take the cap off of the inhaler. 2. Shake the inhaler to mix the medicine. 3. Prime the inhaler. Release one or more sprays if you are using it for the first time or have not used it for more than 7 days. 4. Breathe out slowly and steadily to empty your lungs of air. To take the medicine from the inhaler: 5. Put the mouthpiece close to your open mouth or close your lips tightly around the mouthpiece. 6. Keep your chin up. 7. Begin to slowly breathe in through your mouth. 8. Spray 1 puff by pressing down on the inhaler. 9. Keep breathing in slowly. Breathe in as deeply as you can. 5
To get the medicine into your airway: 10. Take the inhaler out of your mouth if you closed your lips around it. 11. Hold your breath and count to 10 or more. 12. Slowly breathe out through your mouth while puckering your lips. Depending on the dose your health care provider prescribed, you may have to take more than one puff of medicine. If this is the case, repeat steps 5-12. Rinse your mouth with after using your inhaler. Do not swallow the water. Instead, gargle and spit it out. A metered dose inhaler with a spacer usually has 4 parts: A tube-shaped canister of medicine. A cap that covers the mouthpiece. A mouthpiece. A spacer, which may be removable. To prepare the inhaler: 1. Take the cap off the inhaler and spacer. 2. Shake the inhaler to mix the medicine. 3. Attach the spacer to the inhaler if it is not already attached. 4. Prime the inhaler. Release one or more sprays if you are using it for the first time or have not used it for more than 7 days. 5. Breathe out slowly and steadily to empty your lungs of air. To take the medicine from the inhaler: 6. Put the spacer between your teeth and close your lips tightly around it. 7. Keep your chin up. 8. Begin to slowly breathe in through your mouth. 6
9. Press down on the inhaler to spray 1 puff into the spacer. 10. Keep breathing in slowly. Breathe in as deeply as you can. To get the medicine into your airway: 11. Remove the spacer from your mouth. 12. Hold your breath and count to 10 or more. 13. Slowly breathe out through your mouth while puckering your lips. Depending on the dose your health care provider prescribed, you may have to take more than one puff of medicine. If this is the case, repeat steps 6-12. Using a Dry Powder Inhaler Some dry powder inhalers, or DPIs, can only hold one dose of medicine at a time. Other DPIs hold many doses. If your DPI holds only one dose, you will need to put medicine into it each time you use it. Some DPIs have a lever or button that you slide to open. Others have a piece that twists until you hear it click. Some DPIs have an opening that you push medicine into before using it. A dry powder inhaler usually has 3 parts: A container. A valve. A mouthpiece. To prepare the inhaler: 1. Remove the cover or cap from your DPI. 2. Open your DPI if you are required to put medicine into it. 3. Put a dose of medicine into the DPI if you are required to. 4. Breathe out slowly and steadily to empty your lungs of air. 7
To take the medicine from the inhaler: 5. Close your lips tightly around the mouthpiece. 6. Keep your chin up. 7. Take a deep and fast breath using only your mouth. Do not breathe in through your nose. 8. Continue breathing in until your lungs are completely full of air. To get the medicine into your airway: 9. Remove the DPI from your mouth. 10. Hold your breath and count to 10 or more. 11. Slowly breathe out through your mouth while puckering your lips. Repeat these steps as many times as needed until you have taken the number of doses your health care provider prescribed. You should wait at least one minute between each dose. Nebulizers A nebulizer is a device that makes it easier to inhale medicines into the lungs. It provides the medicine in a fine mist that is easy to breathe. Nebulized medication may be a better option for people who have trouble using an inhaler, such as infants or young children. To use a nebulizer, you simply breathe in and out normally through a mask or mouthpiece that is connected to the device. Children with asthma often begin treatment using a nebulizer with a mask. This makes it easier for the child to get the needed dose of medicine without a lot of training. 8
A nebulizer takes more time to use than an inhaler. Nebulizers often take 10 or 15 minutes to give medication. Some nebulizers take longer. Nebulizers come in many different forms. Some nebulizers need to be plugged in to work. Others use a battery. Nebulizers may use an air compressor or sound vibrations to turn the medicine into a breathable mist. This makes them noisier than an inhaler. Nebulizers are often heavier than inhalers. But they are still small and easy to carry. Nebulizers are more expensive than inhalers. They also need more maintenance. How to Use a Nebulizer This section discusses some basics for using a nebulizer. Instructions for using different nebulizers vary. It is important to follow the instructions that come with your nebulizer. A health care provider can also show you or your child how to properly use a nebulizer. In general, to prepare the nebulizer: 1. Connect the hose to an air compressor. 2. Fill the medicine cup with your prescription. 3. Attach the hose and mouthpiece to the medicine cup. To take the medicine from most nebulizers: 4. Place the mouthpiece in your mouth. 5. Breathe through your mouth until all the medicine is used. This often takes 10 to 15 minutes. Some people use a nose clip to help them breathe only through their mouth. It is usually easier for small children to use a nebulizer if they use a mask. To clean your nebulizer: 6. Wash the medicine cup and mouthpiece with water. 7. Air dry the parts until your next treatment. 9
The best way to learn to use a nebulizer correctly is to ask your health care provider to show you how. Then demonstrate it back to him or her to make sure you have it right. Summary An inhaler is a handheld device that is used to deliver medication directly to your airways. Inhalers come in two forms: as metered dose or dry powder inhalers. A nebulizer is an electric or battery powered machine that turns a liquid into a breathable mist. The mist is inhaled into the lungs. A metered dose inhaler, or MDI, is a small aerosol canister that holds medicine. A mouthpiece is attached to the canister. The inhaler is small enough to fit inside a pocket. Some MDIs release the medicine when you push the canister into the mouth piece. Other MDIs release it when you inhale. A dry powder inhaler, or DPI, does not use aerosol to push the medicine. Instead, you get the medicine by taking a fast, deep breath. DPIs are either shaped like tubes or disks. They may have a removable cap or cover. They may contain multiple doses of medication or a single dose. A nebulizer is an electric or battery powered machine that turns a liquid into a breathable mist. The mist is inhaled into the lungs. Nebulizers may use an air compressor or sound vibrations to turn the medicine into a breathable mist. Nebulizers and inhalers work equally well when they are used correctly. You should work with your health care provider to decide which type of device best suits your needs. The decision will be based on your age, your abilities and the type of medication that you need. You may try several different devices before finding the right one. 10