Getting the Most from Your Inhaled Medications
Every now and again I like to get away from my seasonal posts and touch base on some basics of lung condition management. For many people managing a chronic lung condition whether they are “seasoned” or not, you can gain some valuable tips on where you might need improvement. Medication management is a key component of managing your lung diagnosis. If you aren’t using your inhaled medications the right way or the right time of day, you won’t get the greatest benefit to using them.
When a patient comes to see us at our pulmonary rehab, we go over how you should take your medications and the schedule in which you should do so. I have come to find out that many people with lung conditions get off schedule or fall between the cracks because no one has ever taken the time to go over these details. Let’s face it… physician offices are often super busy, and you try hard to capitalize on the little “face time” that you have with your pulmonologist. Typically, the details in which you take your medications aren’t a topic of conversation. Or… you get your prescription for medications from the pharmacy after being out all day and just want to head home to rest instead of sticking around to get the details from the pharmacist. Regardless of the reason, medication administration should be reviewed periodically.
Let’s talk administration…
When taking your inhaled medications, you must use a proper inhalation technique. First shake the canister well. Blow out all of your air. Hold the inhaler to your mouth forming a tight seal with your lips. Push down on the actuator and (at the same time) breathe in deeply. You must then perform a 10 second breath hold after which you should breathe out slowly. I HIGHLY recommend if more than one puff has been prescribed to wait a full minute between puffs. In the past I have had some readers oppose this stance however according to the Physician Desk Reference (PDR) for albuterol it states, “If prescribed more sprays, wait 1 minute and shake the inhaler again. Repeat inhaler steps.”
When taking an inhaled corticosteroid medication, be sure to rinse your mouth after each use. These medications can cause thrush (a furry carpet feeling in your mouth) when not rinsed out well. My suggestion for many of my patients is to keep the corticosteroid in the bathroom near where you brush your teeth so that after using, you can rinse your mouth well and brush your teeth. Keep the caps on dry powder inhalers or the valves closed in order to prevent any moisture from getting to your powder medications.
Let’s talk rescue inhalers…
My personal opinion is that the majority of lung patients that have a rescue inhaler (albuterol) prescribed aren’t using it enough. First of all, if you are reading this blog, I want you to pull your inhaler out and look at the expiration date. If your inhaler is expired, please get rid of it and refill your prescription. Because of the formulation of this drug, it will lose its efficacy the longer you use it past its expiration date. I know many of you are on fixed incomes and want to avoid spending any more money on medications than necessary, but personally my recommendation is that you use it no longer than one month past its expiration date.
Another issue I am finding is that patients that have a rescue inhaler are only using it to rescue them from breathlessness. I think I have stated several times in past blogs that I have never liked the term “rescue” inhaler. “Short acting” or “Fast acting” … yes. Because of albuterol’s nickname, I believe it gives the misconception that you should only use it after you become short of breath. This is just not true. Using it before you do an activity that might make you short of breath will allow you to possibly breathe more comfortably during the activity and will even help to shorten recovery time. Also, I believe that you can administer a better treatment if you are not struggling to get your breath while doing so. Try it. If you know that you are going to perform an activity that may cause breathlessness (like showering, exercising, or cleaning your home) use your rescue inhaler beforehand and see if the task was more comfortable to accomplish. However, let me say this as well… If you haven’t taken your inhaler prior to an activity and need it to recover, go ahead and try to use it to decrease your recovery time.
Lastly, in regard to rescue inhalers, there has been some concern that if you use it, then you will become addicted to it. Fortunately for many people who rely on this medication, that simply isn’t true. Albuterol has a very short half-life which means how long it takes for half of the dose to be metabolized and eliminated from the bloodstream. Or, put another way, the half-life of a drug is the time it takes for it to be reduced by half. Albuterol’s half-life is about 6 hours so you will only be able to feel it’s benefits for 4-6 hours. So thus, the only addictive thing about this medication is the way in which you feel after using it. Keep in mind that you must follow your doctor’s recommendation and only use the medication as often as prescribed.
Remember to rinse and clean your nebulizer often. After each use, your nebulizer and mouthpiece should be rinsed out with warm water and dried. After your last treatment of the day, you should wash it out with warm soapy water using a mild detergent and then dry it. Every 3rd day, you should soak your nebulizer and mouthpiece in a one-part vinegar/three parts water solution, rinse and dry thoroughly. Never store your nebulizer and mouthpiece wet. You do not need to clean the tubing. The tubing should just be replaced when it starts to become hard and less pliable.
Check your air compressor and perform routine maintenance. Examine the cord on your machine to make sure it isn’t frayed. Most home medical equipment should often have preventive maintenance performed and often insurance will cover replacement of certain equipment every few years. We would all like to believe that home care companies keep track of this (and some do) but most home care companies are bogged down and don’t have a fool proof way of making sure everyone’s medical equipment is checked on a routine basis. Review your device’s manufacturer recommendations and see when your machine might be due for a “check-up.”
Timing is everything …
The time of day in which you take your breathing medications is just as important. I have already covered when you should use rescue or quick acting medications. However, your “controller” medications play a major part in helping you to breathe more comfortably and protecting your lungs from flare-ups. If you have a controller that has been ordered “once a day,” I recommend that you take that medication in the morning. Reap the benefits of that medication throughout your day. Sure, it’s supposed to last for 24 hours but doesn’t it make sense to have it in your system at its highest concentration while you are awake?
If your controller is ordered “twice a day,” I recommend that you take it when you first get up and 12 hours later. Stay on a schedule. For example, take the medication always at 8am and 8pm or 7am and 7pm. Be as diligent as possible at keeping the timing the same every day so that you can keep a consistent concentration of this medication in your body at all times. Consistency is the key!
If you have a lung condition that responds to inhaled medications yet don’t feel as though they are helping you, communicate this with your pulmonary doctor. Sometimes it takes a few tries to find the right “cocktail” of medications that will help you to breathe better. I have had two patients in the last month that felt as though their controller inhalers made them feel worse. I put my head together with their physician and tried a nebulized form of a controller and in both cases the patients felt better. Your physician wants to help you feel your best, so communication is the key to feeling your best and sometimes that means going back to the “drawing board” and finding another therapy to help.
Thanks for Reading!
If you enjoyed this blog, I invite you to check out some of the topics I have covered in the past
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