Proper Usage of M.D.I.'s And D.P.I.'s

For those of you who take respiratory medications and take them regularly think about how you take them. Do you know if you are doing it right? Being a respiratory therapist I've realized that some people still do not know how to take their medications. I have had to reteach many people. I know being an asthmatic myself I have taken my inhaler wrong for years. I have recently been doing it the proper way. I will explain how to use each type of inhaler.

M.D.I'.s

M.D.I'.s or meter dose inhalers usually come in the standard inhaler form. They are usually the shape of an L and you have to push the canister to get the medication out. They have names such as Albuterol sulfate and Iprotromium bromide, which are very prominent medications. Most people do not know how to use these. First of all you should push the inhaler. The reason you do this is so that if there is any type of debris in your inhaler you can get rid of it that way. Then, shake the device. This way you make sure the medication comes to the bottom, and also so you get more medicine than propellant which is also n the canister. After shaking it, it's best to wait at least a good minute since you did just push the canister down. Now sometimes you are impatient and well thirty seconds will suffice, but it's best to wait a whole minute because that way the medication and propellant are mixed properly. Now if you have a spacer then attach your inhaler to the back of it, if not, take your thumb and put it close to your lips and them move a few inches from your mouth. Now the reason for the spacer or the distance from your mouth is so that when you do push your inhaler the medication actually goes where it needs to go and it isn't all in your mouth. This makes you mouth powdery and on top of that your medicine isn't going to your lungs. All right before pushing the inhaler make sure you take a deep breath and then blow the breath out. You need to do this so that you can take your medication. Now as you push the inhaler take a slow deep breath in at the same time. Taking this slow deep breath is a good thing because it makes sure that the medication gets all the way down into the bottom of your lungs. If you are using the spacer and you hear a whistle, you are doing it too fast and should slow down. Also make sure while using the spacer you have a nice tight seal around the mouthpiece. After taking in the deepest breath you can hold your breath for at least till the count of ten. Some people have a hard time doing this. Once again try to hold it as long as ten seconds. Meanwhile, you can shake your inhaler while you are doing this so that you can wait another minute before doing another puff. Sometimes it's good to rinse your mouth out if you want, or drink something. The inhaler actually kind of leaves a taste in your mouth. Now for the older adult who cannot do this or any adult who cannot do these steps it is probably best to ask the doctor if you can use a nebulizer instead.

Now for infants and children it's going to be harder. Some children, especially older ones can do this procedure just fine, while others have a hard time. The best thing for infants and children is a mask. Well this gets a bit hard for some people because most infants and children do not like things on their faces, but in the long run they will get their medication. The process is the same first you push it and then shake it. Usually with this process though you do need a spacer and the mask. You can try it with it further from the face but the bad thing is that most of the medicine probably won't get where it needs to and then a nebulizer is the best bet. Back to the spacer and mask. Put the mask to the infants or child's face. Now sometimes a child can take a deep breath, but other wise wait till they take an inhale and then push it. Now make sure you observe them taking ten breaths. Afterward take the mask off and shake the inhaler to start the process again. Most children won't enjoy the mask, but once they figure out how quickly the process they are ok with it. After doing this make sure you wash the infant's or child's face off. Remember with the use of the mask you will put medication all over their face. Just remember it leaves a white powdery substance behind. It's best to have a warm towel ready to make sure there isn't any residue left.

Now these inhalers I have just described are what we call rescue medications. Others include, Combivent, Ventolin, and Xopenex. Use these in emergencies! Please use these, if you don't have inhalers use your nebulizer. If you notice you are using your rescue medications more than usual, go to your doctor. It's really hard during certain times of the year to breath and if you are allergic to a lot of things, so it's best you know when you need help.

D.P.I.'s

D.P.I.'s or dry powder inhalers are another type of medication taken wrong. One of the main medications are Advair and Serevent. One of the most common mistakes I've noticed is that doctors forget that Advair comes in different dosages. Thats just one of my pet peeves when you have to hunt the doctor down to change their orders. Serevent isn't as widely used as it used to be. The way to use them though is quite the same as any discus inhaler. You don't shake these, unless you want to, you won't do any harm. First you have to open it, which involves sliding the thumb grip back. I forgot to mention the nice thumb grip these inhalers have, which help you open the device. Also before I forget there is a little window that tells you how many dosages are left in your inhaler. Next you have to click the little tab on the side. Now the reason why you have to click it, is because there is dry powder in the device, and when you do you have used up one of the dosages. So when you click it you expose it in the little mouthpiece. Before you click it it's wise to take a deep breath and exhale all the way out. Next click the device and right after you click it take a fast deep breath in. Now there is a bit of variations on how I've noticed patients do it. Now some will click it and breath in and out away from the device and then take a fast breath in. Others will breath in and out and right almost at the moment they click it take a deep breath in. Either way doesn't seem like a horrible way to take them, because the technique is the same, and the medication stays in the device. Usually after doing either technique some people take another deep breath in. Now depending on the way the doctor wants you to take the medication you might have to repeat the process again. Make sure to rinse your mouth after this, it will give you thrush if you don't!

One other type of inhaler that is a D.P.I. is a type of handihaler. This inhaler usually involves putting a pill in the device to crush it and inhaling. One of the main ones is Spiriva. First you have to open the pill in the foil package. Then you take the top off of the little inhaler and slide back the mouthpiece to reveal the pill bed. Next you take the pill out of the foil package and place it inside of the pill bed. Slide the mouthpiece back into place. Now some people like to tap the inhaler a bit, so the pill sits perfectly. You can it's up to you. Now you can push the little button on the side which pierces the pill. Now you get to take a deep breath in and out away from the mouthpiece. Make a tight seal around the mouthpiece and breathe in enough to where you can hear the pill inside vibrate in the device. Sometimes if you do it too fast it won't do it, so you have to take another breath in. Make sure to rinse your mouth after usage of this medication it will cause thrush!

Usually with these medications usually will take Advair twice a day and Spiriva once a day usually in the morning. Now heres where there's a problem. Some people use these as their rescue medications. Do not do that! These medications are used to keep you from having asthma attacks. They are what we call maintenance drugs. They should not be used during and asthma attack. when you have an asthma attack you use your rescue medications.

That is how you take most of the popular medications. I will have more information on other types of respiratory medication next time.