Common Inhaler Problems

An estimated ⅔ of patients and healthcare professionals have improper technique while using an MDI.9,   As discussed above, oropharyngeal deposition and actuation-inhalation coordination are the two principal issues with inhalers.  A third problem with technique is insufficient breath-holding. One must hold their breath for 10 seconds to allow for the particles to travel through the airways before exhaling.  One study found that lung deposition of a inhaled drug was reduced by 16% with insufficient breath-holding.

Below is a list of common errors with inhaler devices.

 

Table 3 – Common Nebulizer Problems

Nebulizer Type

Common Issues

MDI without spacer

  • Failure to shake MDI prior to use
  • Not removing cap
  • Failure to hold the inhaler upright
  • Actuation before or after inhalation
  • Not actuating device
  • Not inhaling
  • Inhaling too fast or too slow
  • Inhaling through the nares
  • Failure to recognize the device is empty
  • Insufficient breath holding
  • Improper cleaning of the device

MDI with spacer

  • Failure to shake MDI prior to use
  • Improper seal between mouthpiece and spacer.  Check spacer manufacturer recommendations for proper installation
  • Inhaler not placed at 90 degrees prior to use
  • Improper hand placement on spacer while inhaler is upright
  • Actuating more than a single dose in spacer
  • Seal between lips and spacer is not tight
  • Not inhaling within 2 seconds of actuation
  • Not inhaling after actuation
  • Insufficient breath holding
  • Inhaling through the nares
  • Coughing during inhalation
  • Faulty spacer
  • Improper cleaning of spacer

DPI

  • Not opening device aperture to the full extent
  • Turning device downward after priming dose
  • Shaking device after priming device
  • Incorrectly priming device for dose delivery
  • Exhalation into device
  • Poor inspiratory effort
  • Failure to recognize the device is empty
  • Improper seal between oropharynx and device
  • Improper breath holding
  • Inhaling through nares

SMI

  • Improper cartridge insertion
  • Not priming the dose
  • Improper seal between oropharynx and mouthpiece
  • Covering the side vents during use
  • Not realizing the device is empty
  • Improper timing of actuation and inhalation

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