Asthma Inhaler Technique

Amplified
Checklist

Asthma Inhaler Technique - Amplified

Why Technique Matters

Drug delivery to the lungs depends on:

  • Particle size (1-5 microns optimal)
  • Inspiratory flow rate
  • Breath-holding time
  • Device technique

Poor technique → drug deposits in mouth/throat instead of lungs → reduced efficacy, increased side effects (thrush with ICS).

Studies show 50-80% of patients have suboptimal technique.

Device Types

pMDI (Pressurised Metered-Dose Inhaler)

  • Propellant-driven aerosol
  • Requires coordination (actuation-inhalation)
  • Spacer eliminates coordination problem
  • Always use with spacer in children <6 years

DPI (Dry Powder Inhaler)

  • Breath-actuated (e.g., Turbuhaler, Accuhaler)
  • Requires forceful inhalation
  • Not suitable for <6 years or acute asthma

Nebuliser

  • Continuous aerosol via mask or mouthpiece
  • Used in acute severe asthma
  • Equivalent to pMDI+spacer if technique is correct

Spacer Technique

Why Use a Spacer?

  • Slows particle velocity → less oropharyngeal deposition
  • Allows evaporation → smaller particles
  • Eliminates need for coordination
  • Increases lung deposition from 10% to 20%+

Standard Technique (Older Child/Adult)

  1. Shake MDI vigorously (redistributes propellant)
  2. Attach to spacer
  3. Sit or stand upright
  4. Breathe out gently (not fully)
  5. Seal lips around mouthpiece
  6. Press canister once
  7. Breathe in slowly and deeply
  8. Hold breath for 10 seconds
  9. Breathe out through nose
  10. Wait 30-60 seconds before next puff

Tidal Breathing (Young Child/Mask)

For children who can't do single-breath technique:

  1. Good mask seal (no gaps)
  2. Actuate once
  3. Leave mask in place for 4-6 breaths
  4. Watch for mist in spacer (indicates valve working)

Common Errors

ErrorConsequence
Not shakingInconsistent dose
Multiple puffs before breathingDrug settles in spacer
Breathing in too fastOropharyngeal deposition
Not holding breathReduced absorption
Not waiting between puffsSecond dose less effective

Practical Tips

For crying children:

  • Wait until calm
  • Crying = irregular breathing = poor delivery
  • Distraction techniques help

Spacer care:

  • Wash in soapy water monthly
  • Air dry (don't wipe - static charge)
  • Replace every 12 months

After ICS use:

  • Rinse mouth and spit
  • Prevents oral candidiasis
  • Prevents systemic absorption from swallowed drug