Don’t Forget This Inhaler Step (and a Video)

A recent email conversation with a friend and regular reader prompted me to comb through YouTube this morning for a video about inhalers and spacers. You see, my friend has a daughter with asthma also, and no one’s ever given her this crucial bit of information in the inhaler process: asthma patients should hold their breaths for 10 seconds after inhaling, so the medicine stays in their lungs longer.

I wish my friend’s experience were the exception, but it’s not. AG also used the inhaler/spacer combo for a ridiculous amount of time before any medical personnel told us counting to ten before the exhale would help her more, and you know what? It really does.

This is one of those tips every asthma parent or patient should know and it’s all over the asthma websites, yet like so many other guidelines somehow it falls through the cracks. Here again, I’m wondering why asthma diagnosis doesn’t go more like this:

This is asthma.
These things tend to set it off.
This is how you treat it.
These are some things to keep in mind.

Instead of this:

Um, your daughter has asthma. Fill this prescription for a nebulizer, and give her an albuterol treatment whenever she’s breathing too fast.

Anyway, check out the inhaler visual from a pediatric pulmonologist:



Lists make more sense to my brain, so here’s that format:

1. Your mouth should form a tight seal around the mouthpiece of the spacer.
2. Squirt the medicine, and breathe in slowly.
3. Hold your breath for 10 seconds.
4. Exhale.

AG even takes the process one step further, on the recommendation of yet another former pediatrician. When she exhales into the spacer, she breathes in again to capture any residual medicine. Is this step redundant? Possibly, but it makes me feel better.

252 responses to “Don’t Forget This Inhaler Step (and a Video)”

  1. Asthmagirl says:

    Um yes… holding your breath. Excellent suggestion and one it took me about a year to figure out. Another clever tip- relax your tongue. The meds do no good if they hit your tongue.

  2. Blessedmomof4 says:

    Ok, Asthma Mom AND Asthma Girl….you both Rock! I am trying to figure out why my poor AG isnt doing well on her inhaler of Xopenex but doing GREAT on her nebulizer of the same med. I think it is both of the above steps you mention……..my 11 yr. old is teeny tiny and her mouth is so petite. I think she blocks the med with her tongue and then she gets all SHAKEY b/c the med goes in through her mucous membranes (under the tongue etc!) and directly into her blood stream. Anyway, this is my take on it but coming from this 63 lb. 11 yr. old, she said last night “Mom, I like this nebulizer of Xopenex so much better. I dont feel all crazy shakey after using it!” And this is telling b/c actually the Xopenex (1.25mg) I am using is a much higher dose than the inhaler med. (45mcg/puff and she takes two) Anyway, I need to run…..but thanks so much to both of you for something new to consider….and ask her new Dr. about. I need to schedule a f/u for her anyway…….and I will try to have her learn to relax her tongue and also watch the U-tube clip (I havent had a chance yet to watch, but the more I can educate her without her rolling her eyes at me! the better :) …….so the video clip can be another tool for her to learn and not always be me harping on her! Thank you!!!! :)

  3. Steve says:

    You’d be surprised at how many people ( medical professionals included) , don’t know how or why to use a spacer.

    The Ph monitor thingy test was totally normal and the tube is finally out. I have one more “See what makes Steve tick” test, next Monday. Actually, a fellow blogger/marathon runner from Canada is going to be in the SF area and is going to witness the test.

    And YES, that’s a robot in my kitchen. My partner used to make props for the movies , television , etc. His specialty was maniquins. Our home is somewhat of a museum.

    Hope Asthma Girl is doing OK. Pollens are going to be out in force really soon:-)

  4. AndieBeck says:

    Hmm thanks for this tip! I have never heard this before. My DH is just 3.5 yo so I’m not sure if I could get this through to him, but when/if we need the inhaler & spacer for him again we’ll give it a shot. As I recall, we kept the spacer to his face for 20 seconds or something while he breathed norally.

    All I know about the spacer is that it makes it easier for a younger child to actually get the medicine.

    I’m doing a trial of taking my inhaler at night for a week, then I’ll go off it to see if I notice any changes. I am leaning towards believing I do actually have mild asthma, though. It seems natural to hold my breath a bit after taking a dose, but I sure haven’t been holding for 10 seconds!

    Steve, it sounds like you are making progress – I haven’t had a chance to check your blog or anything but I wish you the best of luck.

    Amy, thanks again for valuable information!!

    Ps. If you don’t mind giving me your personal take … do you think I should push to have my lung function measured etc? On the one hand it doesn’t seem like it’s very serious. On the other hand, I’d like to have a baseline function because who knows what the future will bring. The issue being in Canada, where medical care is available to all (which I feel is a great thing), I’m sure people with more serious illness should get priority. So I don’t know if I should push this or not.

  5. freadom says:

    I think that many doctors are so fucused on diagnosing and treating they fail to properly educate. That’s why it would be nice to have more RT involvement in this area.

    When I have an asthma patient in ER, I almost always determine they use their inhalers incorrectly. And many of them haven’t even heard of a spacer. I found one study that shows that using inhaler with a spacer provides for 175% better distrubution of the drugs, and I tell my patients this. Too many doctors don’t.

    Good video. Good post

  6. Amy says:

    That’s a good point, Asthmagirl–thanks for adding!

    Blessedmom, You’re welcome. :) I hope she feels better soon.

    Steve,
    That just makes me so sad, although I’m not surprised. I’m very happy your results came back normal and wow–you should post some pictures of other props you’ve got lying around. What a fascinating job.

    Andie,
    I’d totally go get a baseline for a few reasons. One is that I wish I had taken my daughter to a pulmonologist and gotten lung function tests done much sooner because I think we would have gotten things under control for her faster.

    Another reason is that pulmonary function tests might give you a clearer diagnosis beyond the trial and error with an inahaler.

    Finally, adult asthma is usually harder to treat than asthma in kids. (ask Asthmagirl) It’s my understanding that’s usually true for adult-onset and I know you may have a mild case that’s been there all along rather than just now developing, but if it weren’t me–I’d go ahead and get it done, just to be safe.

    Hope that helps!

    Rick,
    I’m always harping on this, but I’ll say it again. I’ve gotten some of the best advice ever from nurses and RT’s, people who deal with asthma patients one-on-one. I’m SO glad you guys take the time to teach.

  7. cara says:

    I hope this works..my computer is still broken so I am blogging from my phone!!! I’m desperate. this was great advice for me and my reactive airway child!! once we changed the way we did the inhalers things began to progress much faster!!

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