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Proper use of inhaler is a key step to better breathing
Proper use of inhaler is a key step to better breathing Is he using the nebulizer correctly? Has anyone watched him use it? Also, is he following the proper procedure for the nebulizer?

In my role with Nightingale Home healthcare, I am often asked questions by our professionals in the field about a patient’s medications. I chose to share one of the recent questions here, with the hope that some of our readers may benefit.

Q: A client takes breathing treatments using albuterol; his prescription calls for use of a vial every six hours as needed; he reports using as many as twelve to twenty-five vials per day. Are there concerns?

A: Yes. There are concerns. Is he using the nebulizer correctly? Has anyone watched him use it? Also, is he following the proper procedure for the nebulizer? Proper use of a nebulizer is as follows:
  • Connect the hose to the air compressor.
  • Fill the medicine cup with the albuterol solution.
  • Attach the hose and mouthpiece to the medicine cup.
  • Place the mouthpiece in his mouth. Have him breathe through his mouth until all the medicine is used. (Most times, this takes ten to fifteen minutes). If there is trouble breathing through the mouth, a nose clip may be placed on the nose to ensure mouth breathing. Some people may prefer a mask instead.
  • Wash the medicine cup and mouthpiece with water and air dry until the next treatment.
Other concerns
His medication list indicates that he is ordered to use an Advair inhaler twice daily...but is he using it correctly?

Advair has an inhaled steroid and a long-acting bronchodilator which should provide relief for twelve hours. However, it has to be used properly to work. The proper use of an Advair inhaler is outlined as follows:
  1. The Diskus inhaler must be opened, and then “clicked” to properly release the dose of powdered medicine into the chamber (this is accomplished by pushing the lever on the side of the inhaler all the way back until it “clicks”).
  2. The medicine is now ready to be inhaled. To inhale, he should exhale completely before bringing the inhaler to his mouth, place the inhaler in his mouth and inhale as deeply and completely as possible. Have him hold his breath for ten seconds or as long as he can after inhaling. All this time, the inhaler should be held in a level position to ensure the delivery of medication.
The Advair Diskus inhaler has a number system on it to inform the user of the number of doses remaining. This number is used for reordering purposes, but I advised this particular care giver to check that the patient was using it twice daily.

My final advice was that after checking out all the above suggestions to verify the patient was doing them correctly but still requiring the “rescue” nebulizer inhalation of albuterol twelve to twenty-five times per day, then another step in the treatment should be added to his medication regimen.

The next step would be the addition of an inhaled corticosteroid, like Pulmicort, or the addition of a low dose of oral steroid, like prednisone used on a daily basis. The over use of the albuterol was increasing the patient’s heart rate, which is undesirable.

I also advised the caregiver that there are some good instructions on YouTube about the use of an inhaler that she might help him access. If after observing the patient successfully using the nebulizer and the Advair Diskus inhaler, then his doctor should be contacted for the addition of another medication to treat his dyspnea or shortness of breath. Using the albuterol nebulizer twelve to twenty-five times per day is too much.

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"Proper use of inhaler is a key step to better breathing"
   authored by:
Tamara Dulin, R.Ph., is a registered pharmacist with Nightingale Home Health Care in Carmel, Indiana. A 1991 graduate of Butler University College of Pharmacy, she has spent the majority of her career in consulting. She is a past president of the Ind...

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