Editing Inhaler (section)

==Proper use==
{{how-to|section|date=August 2021}}
It is important to use proper techniques when administering medications through inhalers.

Proper use of inhalers often involves initial [[deep breathing]] (which involves mostly the [[Thoracic diaphragm|diaphragm]]'s movements), and then rapid breathing<ref>{{Cite journal |last1=Zeinali |first1=Faeze |last2=Mohammad Karimi |first2=Naser |last3=Jafari |first3=Mohamadali |last4=Akbarzadeh Moghadam |first4=Ebrahim |date=2021 |title=Rapid and Deep versus Normal Breathing in Salbutamol Inhalation Effectiveness; a Letter to Editor |url= |journal=Archives of Academic Emergency Medicine |volume=9 |issue=1 |pages=e42 |doi=10.22037/aaem.v9i1.1122 |issn=2645-4904 |pmc=8221548 |pmid=34223187 |doi-access=free}}</ref> (which involves most of the muscles of respiration, such as external and internal [[intercostal muscles]]<ref>{{Cite web |date=2022-03-24 |title=How the Lungs Work - How Your Body Controls Breathing {{!}} NHLBI, NIH |url=https://www.nhlbi.nih.gov/health/lungs/body-controls-breathing#:~:text=The%20diaphragm%20is%20the%20main,such%20as%20during%20physical%20activity |access-date=2024-01-29 |website=www.nhlbi.nih.gov |language=en}}</ref>) during intake of one or more puffs from the inhalers.

Improper use of inhalers is very common, can lead to distribution of the medicine into the mouth or throat where it cannot create its desired effect and may cause harm.<ref name=":0">{{cite journal | title = Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma-Summary Report 2007 | journal = The Journal of Allergy and Clinical Immunology | volume = 120 | issue = 5 Suppl | pages = S94-138 | date = November 2007 | pmid = 17983880 | doi = 10.1016/j.jaci.2007.09.043 | author1 = National Asthma Education Prevention Program }}</ref><ref>{{cite journal | vauthors = Cho-Reyes S, Celli BR, Dembek C, Yeh K, Navaie M | title = Inhalation Technique Errors with Metered-Dose Inhalers Among Patients with Obstructive Lung Diseases: A Systematic Review and Meta-Analysis of U.S. Studies | journal = Chronic Obstructive Pulmonary Diseases | volume = 6 | issue = 3 | pages = 267–280 | date = July 2019 | pmid = 31342732 | pmc = 6872219 | doi = 10.15326/jcopdf.6.3.2018.0168 }}</ref><ref>{{Cite journal|last1=Sanchis|first1=Joaquin|last2=Gich|first2=Ignasi|last3=Pedersen|first3=Soren|date=1 August 2016|title=Systematic Review of Errors in Inhaler Use: Has Patient Technique Improved Over Time?|journal=Chest|language=en|volume=150|issue=2|pages=394–406|doi=10.1016/j.chest.2016.03.041|pmid=27060726|s2cid=27941333 |issn=0012-3692|doi-access=free}}</ref> Education on the correct use of inhalers for delivery of medications is a commonly cited topic in medical studies and a great deal of thought has been put into how best to help people learn to use their inhalers effectively.<ref>{{cite journal | vauthors = Harris K, Kneale D, Lasserson TJ, McDonald VM, Grigg J, Thomas J | title = School-based self-management interventions for asthma in children and adolescents: a mixed methods systematic review | journal = The Cochrane Database of Systematic Reviews | volume = 1 | pages = CD011651 | date = January 2019 | issue = 1 | pmid = 30687940 | pmc = 6353176 | doi = 10.1002/14651858.CD011651.pub2 }}</ref><ref name=":4">{{cite journal | vauthors = Maricoto T, Monteiro L, Gama JM, Correia-de-Sousa J, Taborda-Barata L | title = Inhaler Technique Education and Exacerbation Risk in Older Adults with Asthma or Chronic Obstructive Pulmonary Disease: A Meta-Analysis | journal = Journal of the American Geriatrics Society | volume = 67 | issue = 1 | pages = 57–66 | date = January 2019 | pmid = 30291745 | doi = 10.1111/jgs.15602 | doi-access = free | hdl = 10400.6/9162 | hdl-access = free }}</ref> Below is a description of proper inhaler technique for each different type of inhaler as well as a helpful video explaining what the text states.

[[File:Using an inhaler.webm|thumb|Using an inhaler]]

===Meter-dosed inhalers===

# The mouthpiece is removed and the inhaler is shaken for 5–10 seconds.
# The inhaler is gripped with mouthpiece on the bottom and canister on top.  A finger is placed on the canister to allow for delivery of medicine.
# Deep inhalation is done until no more air can be taken into the lungs. 
# Deep exhalation is done until most of the air is out of the lungs.
# Once deep exhalation is done, mouth is placed over mouthpiece.
# As the next deep inhalation begins, the canister is pressed down to release the medicine into the lungs.
# Slow deep breathing is continued and breath is held for 5–10 seconds, keeping the medicine in the lungs for a longer time period and preventing escape of aerosolized form of the medicine.
# Complete exhalation is done again. If multiple puffs of the medicine have to be taken, steps 1–5 are repeated after waiting for 15–30 seconds.
# Mouthpiece is replaced.<ref name=":0" />

===With spacer===
Spacer is placed at the mouthpiece of a meter-dosed inhaler while keeping mouth at the end of the spacer. After pressing the canister of the inhaler, the medicine will linger inside the spacer, allowing for the user of the inhaler to directly absorb medicine into their lungs.<ref name="nationwidechildrens-spacer-and-mouthpiece">{{cite web | url=https://www.nationwidechildrens.org/family-resources-education/health-wellness-and-safety-resources/resources-for-parents-and-kids/how-to-use-an-epipen/epinephrine-myths-and-facts/how-to-use-an-inhaler-with-a-spacer-and-mouthpiece | title=How to Use an Inhaler with a Spacer and Mouthpiece }}</ref> Deep breathing is done to be ready for the delivery of the medicine to the lungs; this minimizes need for coordination of breathing with inhaler activation.<ref name=":0" /> Cleanage of the spacer regularly with warm soapy water is recommended.<ref name="nationwidechildrens-spacer-and-mouthpiece" /><ref name="asthma-nz-foundation" />

===Dry powder inhalers===
# Inhaler medication chamber is prepared (this will be different based on the type of inhaler but will involve preparing and opening the chamber with the medication)
# The inhaler is held with the chamber pointing towards the patient and complete exhalation is done with their head turned away from the inhaler.
# Mouth is placed over the chamber and a quick, deep breath is taken allowing medication to dispense in the lungs.
# Breath is held for 5–10 seconds and then slow exhalation is done.
# After waiting for a few minutes, steps 1-4 are repeated if another dose is needed.<ref name=":0" />

===Soft mist inhalers===
# The inhaler is primed by loading the cartridge and discharging the inhaler until a fine mist is visible ([[:File:Using an inhaler.webm|more explanation in the video]]).
# Once complete exhalation is done, mouth is placed around the mouthpiece while leaving space for the small holes on the side of the mouthpiece.
# Slow inhalation is done while simultaneously pressing the button to release the medication.
# Breath is held for 5–10 seconds.
# Slow exhalation is done and steps 1-4 are repeated if another dose of medication is required after waiting for a few minutes.

If the inhaler is used every day, it usually has to be primed the first time using a new cartridge, and it may need to be primed again if it has not been used in multiple days.<ref name=":0" />

===After use===

If using inhaled corticosteroids, one should wash the mouth out directly after use of an inhaler. This helps to prevent [[mouth infection]]s that can occur due to [[immunosuppressant]] effects of corticosteroids.<ref name=":0" />

===Nebulizer===
# Mouth is placed over mouthpiece or face mask is placed over nose and mouth
# The nebulizer machine is turned on.
# Normal breathing is done for 10-20 min (or time allotted for treatment).
# Machine is turned off and face mask/mouthpiece remove is removed.<ref name=":0" />