Inhaler technique: Today, at a hospital... - Asthma UK communi...

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Inhaler technique

Wheezycat profile image
Wheezycat

Today, at a hospital lung function test, I was told that to do the ‘one breath and hold’ technique is better than tidal breathing, if I can, that is. I have never been told that before, so now I have to rethink. Also, I am worried that my fingers won’t have enough strength to do this. I also thought, that in that case, you can put a puff in your spacer as it were - as I then press with the heal of my hand it is easy - and that is also OK. Now I feel confused. I have just looked at the AUK website but it was not clearer about which was better. Any views and suggestions? It

34 Replies
Lysistrata profile image
LysistrataCommunity Ambassador

I've had one or two people tell me that, but they gave no good reason for it. Others who I consider better qualified to comment (ie respiratory physios and not the asthma nurse whose view I don't rate on pretty much anything) have told me either is fine. I said I can do breath hold fine (asthma nurse was convinced I just couldn't manage it), but tidal is just easier, because I'm lazy lol. The physios said sure whichever works for you, either is fine.

Did they give a good reason for why breath hold is better? I do find people like to make pronouncements on this kind of thing without much good evidence, so I tend to ignore them unless there's a compelling reason beyond 'this is how I tell people to do it'.

Oops sorry...my cynicism coming out there lol. You could always ask AUK if not sure? If tidal breathing works better for you though I think they might say even if there is a small difference, it's not enough to switch if you're proficient and comfortable in one method?

Wheezycat profile image
Wheezycat in reply to Lysistrata

As usual, Lysistrata, you have words of wisdom! Yes, it is worth always remembering that there are conflicting views. A cynical- ish (or questioning) attitude is a good thing to have.

I will contact the AUK nurses as I have a couple of questions about this. This technician was pretty certain of what he said, and also told me that people with arthritic fingers instead press the inhaler button against a wall.......hm, I am not convinced. So a chat with those nurses is such a sensible idea.

Lysistrata profile image
LysistrataCommunity Ambassador in reply to Wheezycat

Yes definitely ask the nurses!

I"m sure there are some great and knowledgeable lung function technicians, but I often find them the worst at having Opinions and refusing to budge on them. Again I"m sure it's not all of them (and it seems much less common if they're a physiologist not a technician), but sometimes it seems like they know a little, don't think about the reasoning behind it, and become very dogmatic. I've got really fed up with some of them telling me stuff I know is wrong and that they have no business saying to me.

I am now cynical about pretty much everything to do with all this! But the AUK nurses usually escape that lol. Hope you get some helpful answers 🙂

Wheezycat profile image
Wheezycat in reply to Lysistrata

I am sure you are right! I have never had this thorough an examination before , just the smaller desk top spirometers and a huge contraption which predated anything electronic. I was apparently referred for this well over a year ago, and more recently re-referred I think, so I don’t have wide experience of this. This one did feel rather overdue. I think the guy was a technician, I assumed so. He was very pleasant, and didn’t feel dogmatic, just that it was the best method. I will seek advice - not least due to my lack-of-strength fingers. Pressing the puffer against a wall does not seem a good idea to me!

Gareth57 profile image
Gareth57 in reply to Lysistrata

Wouldn't it depend on the inhaler and whether you use a spacer or not? I DPI could be either, a pump would need to be I single deep breath and hold and a pump with spacer would be either. I think many health care professionals fail to consider the type of inhaler or the spacer option and come out with a standard instruction.

Wheezycat profile image
Wheezycat in reply to Gareth57

I use an MDI, Fostair, with a spacer. Obviously it depends on what inhaler it is, but the advice was specific to MDIs with spacers. (I used to be on a DPI, but due to thrush issues it was changed to an MDI with a spacer.)

I can't visualise pressing an inhaler against a wall to activate it.

My only recent experience has been with dry powder inhalers so one deep breath in is the norm and the first hurdle is a good exhalation, emptying the lungs needs focus (well i have to focus). The Asthma UK give the two options for spacer use here asthma.org.uk/advice/inhale... guess if you can tolerate the one breath method with holding your breath afterwards then it would be worth monitoring the results in comparison to your tidal breathing method. If there's no improvement to your symptoms/ peak flow over time at least you can then report your experience with your doctor and say which method you prefer. We all respond differently to meds and my guess is we all respond differently to technique as well. So it boils down to what method suits you best, results wise.

Wheezycat profile image
Wheezycat in reply to Poobah

My plan is to try to get hold of the AUK nurses, today I hope, to have a chat about it. My slightly arthritic fingers means I press mine in a different way which works well, but I can’t do that with the spacer already in position as I am not double jointed. The whole thing feels really awkward.

Poobah profile image
Poobah in reply to Wheezycat

Good idea, Asthma UK are very helpful.

I've never heard of the tidal I've always been told one breath and hold ever since I have been able to do my own inhaler ( had asthma since 2 now 40) could someone please explain what tidal is as I'm now curious about this.

You can see it on the AUK video, link below. I always find it easier, and particularly good when you are having a significant flare and struggle with breathing.asthma.org.uk/advice/inhale...

That might be why I have never heard of it because I don't use a spacer. I've never got on with them so taking direct from the inhaler would be the breath and hold just wondering do you think that your doctor or specialist might have for some reason thought you use without a spacer or was implying this to you.

Also thanks for the video

No, no reason for that, and what brought it up was to administer some salbutamol before another test, all done with a spacer. I by far prefer them. When I was particularly poorly some years back I discovered what a difference it made, for me anyway, so I am a total convert to them. I would really struggle without.

That is strange then I remember using them a few times when I was poorly and I couldn't get the breath to take my inhaler so I asked for a spacer just until I could get the breath to do normally asthma nurse asked me why don't I keep to using it I said I can't hold them and it hurts both my hands and mouth more than the inhaler alone but at the moment it's the breath I can't get my breathing was too shallow and I said I need to have one so I can take several small breaths without losing the one dose. ( I have very small features for a grown-up that is why I have trouble)

Have you tried the aero chamber spacers the mouth piece is almost the same size as the inhaler and the chamber is easy to hold . I was given the larger clear plastic one for my daughter when she was young and the asthma nurse was horrified and swapped us all to the aero chamber ones as they are far more compact .

Yes I was given that last time and I got so fed up with dropping it as it is too big still just shorter the volumeatic ( big clear one you mentioned) at least I could have it balancing on my palm so it's actually not advisable to give or hassle me with spacers unless I ask for one as for me there nothing but trouble and I end up throwing them.

Lysistrata profile image
LysistrataCommunity Ambassador in reply to Rlbee1974

I guess the large one might be difficult for a small child to use by themselves, but I had one as an older child and it was fine. As far as I'm aware the larger volume one actually allows for more deposition of drug in the lung Vs the small volume, so can be preferable to use where possible (eg at home, and/or with adult help where needed).

The small volume one does still get more into the lung than no spacer of course so definitely worth using. I'm just surprised the asthma nurse would be so against the large one like that for adults and children as a general principle - of course I realise you may have had specific reasons you mentioned to her for a large one to be tricky.

I use a large one at home and a small one out and about (Able not Aerochamber, have used both but I like being able to store my inhaler inside the spacer to save space in my bag).

twinkly29 profile image
twinkly29 in reply to Lysistrata

People I've seen in hospital have been given the big spacers by our ANs (who are very good ANs!) Others come in with their own, of either sort, and they're ok to use those.

I literally don't understand anyone being "alarmed" or whatever at either spacer or any technique. As long as a technique (a) is done correctly and (b) works well for the person doing it, then that's the right thing.

Wheezycat profile image
Wheezycat in reply to twinkly29

I use the Aerochamber. A few years back, having discovered how much they help, I searched for something smaller than a volumatic, which I found cumbersome when out and about. A supermarket pharmacy introduced me to the aero chamber, and what a relief that was!

twinkly29 profile image
twinkly29 in reply to Wheezycat

So to me, that's the right one for you, with whichever technique you prefer.

It's like saying everyone has to use MDI ventolin when others might do better with the easybreathe type.

Wheezycat profile image
Wheezycat in reply to twinkly29

Quite!

Wheezycat profile image
Wheezycat in reply to Rlbee1974

That is the one I do use, all the time!

So one thing leads to another. Unfortunately the AUK nurses are in training today, so I have to wait, impatiently, of course. One concern for me is lack of good finger strength due to a spot of arthritis in said digits. So what to do. It turns out there are aids to press inhalers, and I have sent off for one, experimentally. If it really works at all it could easily work with a spacer. But then there was also the idea to try to improve my finger strength, so something else has been sent for to get me exercising them specifically. It had plenty of stars and was relatively cheap. If more strength could be achieved, it could help with other things as well. My overall hands are fine, it is literally just my fingers that are not quite what they were.

When I had my test at the hospital last year with a CNS. She watched my tidal technique, never stopped me from using it just asked why? I said I found it easier. After she gave me a leaflet which showed/listed both techniques.

This wasn’t as such a test on my technique, it was a lung function test, but it involved taking salbutamol at one point which lead to the discussion. I am not convinced and I will talk to the AUK nurses once they are open again.

Mine too was a lung function and also had FeNo. I did mention tests at the hospital. Part of that was ventolin for me and she watched my technique.

Now you say it I may also have had the FeNo test. The first one, on different apparatus was to check/measure inflammation.

It can be very confusing when health care professionals give what appears to be confusing or conflicting advice. My understanding is that both methods are acceptable.

I wonder if the one breath method was mentioned as it suggests that the air may travel deeper during delivery? Of course, this depends on the depth of lung breathing used. We all breathe, but our pattern of breathing can be altered due to external factors. Think of the difference between a baby lying sleeping and how its chest moves, compared to an adult....... never mind the way a tight chest alters things!

I recently had spirometry done by a technician. He was trying to tell me “to keep breathing “ when I was at the end of my breath and had my natural “pause”🙄🙄

Regarding your finger arthritis. I hope you find the exerciser helpful. However, just be mindful if you have bony changes due to your arthritis, then that may impact your ability. I have arthritic thumbs. My joints don’t have the range of movement that they once had due to the bony changes.

Absolutely re the arthritis! But I need to keep my fingers as strong as I can.

I was advised to use the tidal breathing technique by my dairs nurse a while ago when I was struggling to hold my breath after an exasperation and now I just do it cause I prefer it, unfortunately can’t do it with my spiriva so have to do the breath hold for that.

Yes, I, too, like it! It reminds me of waves going in and out. My only concern about myself is that when I am on autopilot I may rush it without noticing. For all of that, somehow it feels more effective, for me anyway. But I will discuss it all with the AUK nurses as soon as I get hold of them.

Hi I mix and match, and was told I could do either with MDI & Spacer, timing I think is important. I tend use one breath and hold when I am well, and tidal breathing if unwell. I do keep an eye on peak flow, not sure if there is an enormous difference? I tend to of stepped up with my inhaler if I am doing tidal breathing, because of low peak flow.When my Daughter (she has asthma too) was little, ie a toddler, we did tidal breathing together. So she could learn to use her inhaler and spacer properly.

R x

P.S not sure about this, but I think you can get an arthritis attachment for inhalers if you are struggling to push down, Asthma UK nurses should know about that. Also I think there are inhaler videos on the Asthma UK website, I was involve ages ago in critiquing them. May have changed by now though.

Wheezycat profile image
Wheezycat in reply to risabel59

Thank you. I am still working on my ultimate way, but breaking habits can be hard especially when you go on automatic pilot. As for my grip, I have already sent off for a small gadget to see if it helps, though I also have worked out an alternative method to the index finger /thumb press. Also I have sent off for some finger strengthened equipment (just a small outlay). Part of the issue is not rusting the strength of my fingers as several of my joints are mostly mildly affected, but enough to reduce strength.

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