Guide Health: Breathing easier with your inhaler

Many types are available, but many people don't use their inhaler correctly

Being unable to catch your breath is certainly scary, and unhealthy. While you may think of asthma as the most common cause of breathing problems, chronic obstructive pulmonary disease or COPD accounts for most shortness of breath among older people. It is estimated that 1.5 million Canadians have a COPD diagnosis, but an equal number may also have the condition and not realize it.

The most common causes of COPD are smoking and air pollution, and it is only after decades of exposure that breathing problems occur. About 15 per cent of smokers will develop the disease, and of people who have COPD, 90 per cent of the cases are attributed to smoking. Combine the requirement of long-term exposure with the aging Canadian population, and you will see that COPD is only going to become more common.

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COPD is characterized by shortness of breath or dyspnea, coughing, wheezing, sputum or excess mucus production, tiredness, lack of energy, and increases in chest or respiratory infections. Longterm damage to the lungs makes breathing difficult, although you may attribute your deteriorating lung function just to getting older. Because of this, by the time the symptoms are severe enough for you to go to the doctor, lung damage may already have occurred.

Two types of drugs are commonly used to treat COPD. These are bronchodilators which open up airways, and anti-inflammatory drugs which reduce airway inflammation. These drugs are often used via inhalers, which makes sense because then the medication is delivered directly to the lungs.

Bronchodilators are either anticholinergics or beta-agonists. Anticholinergic medications work through the cholinergic nervous system to relax and open up airways while beta-agonist medications affect beta receptors in bronchial tissue. There are both short-acting formulations such as the anticholinergic ipratropium and the beta-agonist salbutamol meant for immediate relief, and long-acting formulations such as the anticholinergic tiotropium and the beta-agonist salmeterol. It makes sense that you would use a combination of bronchodilators and a combination of short- and long-acting formulations for maximum effectiveness.

Anti-inflammatory drugs are usually inhaled corticosteroids such as fluticasone. Regular use is needed to keep inflammation controlled. However, you do need to rinse your mouth after inhaling to prevent mouth and throat yeast infections.

Often combination inhalers are used, that is, an inhaler that contains two different bronchodilators or both an anti-inflammatory drug and a bronchodilator. Inhalers are either metered-dose inhalers, which are pressurized canisters able to deliver a specific dose, or breath-activated inhalers, which depend upon an inhaled breath to deliver the medication.

Many types of inhalers are available, both in terms of medication ingredients and delivery systems, but studies show that anywhere from 20 to 75 per cent of people don’t use their inhaler correctly. Obviously, if you count on an inhaler, you need to have good technique and you may need to try several types of inhalers to find one that is effective and that you find easy to use.

It goes without saying that you should read all the instructions before using a new inhaler. Many inhalers have websites and supplemental information that will help. Keep practising your technique, even in front of a mirror, and don’t assume that because you have used your inhaler for a long time, your technique is good! Count out all time periods, because what you may think is a minute may not be a minute. And, if you are having problems, consider using a spacer device, or changing from a metered-dose inhaler to a breath-activated one.

To keep airways open, remembering to use your inhaler is key. If you find yourself forgetting, maybe a change to an inhaler with longer-acting ingredients would mean a once or twice daily dosing, although you probably will still need a “rescue” inhaler like salbutamol. And, don’t forget to carry it with you, because you don’t want to be caught short of breath!

About the author


Marie Berry is a lawyer/pharmacist interested in health and education.



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