Lessons for life - The inhaler technique

An elderly lady presented with 2 days history of cough and wheezing. She has had recurrent wheezing and was followed up at a local hospital. She was on regular salbutamol 2mg tablets three times a day and oral theophylline 125mg twice a day.

On examination, she was dyspnoeic and had bilateral wheezing. She was managed with oral antibiotics, regular nebulizations and a short course of oral prednisolone. The consultant asked the house officer to start her on an MDI inhaler and spacer at the time of discharge.

2 days later she again admitted to a local hospital with wheezing. She got better with nebulization and discharged on the following day. A day later she again readmitted with wheezing and transferred back to the tertiary hospital.

Her response to nebulization was good. She was nearly asymptomatic the next day morning. The consultant asked the house officer to check the inhaler technique as she got recurrent admissions.

She took the spacer out, fixed it.
Took the inhaler out, removed the cap, shook it.
Fixed the inhaler to the spacer.
Breathed in and out 10 times.

Fine, wasn't it?

She never pressed the inhaler!

Lesson
  • You can prescribe all fancy medications, but make sure the drug is delivered to the patient!
  • Always teach techniques carefully. Teaching our patients is notoriously difficult. They never listen.
  • Always check the technique before discharge.
  • Managing asthma with oral salbutamol is no longer recommended.

  • Inhalers are available in most of the hospitals.
  • Even if they are not available, you can get them down a DP haler and the DP capsules are very cheap.
Homework
  • Learn the proper technique of using inhalers
  • Learn about different types of inhalers and pros and cons.
  • Learn about different inhaled medications available and when and how to use them.
  • Read about the common causes for poorly controlled asthma.


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