Q. I was interested in your discussion of asthma, because my 7-year-old has it. When you talked about inhalers, though, you didn't mention the importance of using spacers, the devices that help people, especially children, get more asthma medicine from an inhaler.
Also, I wasn't sure in what order the various anti-asthma drugs should be used.
A. Spacers can help get the medicine into the lungs where it belongs. Many people don't use inhalers properly. They don't activate the inhaler spray correctly, in time with their taking in a deep breath.
Often, most of the medicine is deposited in the back of the throat or isn't even inhaled into the lungs at all.
Another common error is putting the mouthpiece of the inhaler inside your mouth. This technique causes more of the medicine to be deposited in the mouth or throat, rather than inhaled. Most experts recommend that the inhaler be held about an inch and a half in front of your open mouth.
For people, such as children, who can't coordinate their breathing in with the activation of the inhaler spray, a spacer can really help. This device better disperses the medicine in the air you inhale, rather than having the larger particles of the drug deposited in your throat (see top illustration).
Here's how to properly use your inhaler if you don't use a spacer.
Shake the inhaler well before each use.
Hold the inhaler about an inch and a half (two finger-widths) in front of your mouth (see second illustration).
Open your mouth wide.
After breathing out normally, start to take a slow, deep breath in.
Activate the inhaler after starting to breathe in, and continue breathing in for about five more seconds.
Hold your breath for 10 to 15 seconds if you can, then breathe out slowly.
Wait a minute or two before repeating the dose. This will give your airways a chance to open up and allow the second dose of medicine to reach even deeper into your lungs.
As for which asthma drugs to use when, remember that some drugs work best during an acute attack, while others work only to prevent attacks. In addition, some drugs can be used both short-term for acute attacks and long-term to prevent attacks or lessen their severity.
Many experts recommend an inhaled beta-agonist for acute attacks and add a short course of steroid pills if needed. For prevention, many doctors use beta-agonists or theophylline, with or without an inhaled medicine, such as cromolyn or an inhaled steroid.
Recently, there's been an unexpected rise in deaths from severe asthma attacks. It's important to take asthma seriously and get medical help for any attack that doesn't respond promptly to your usual treatment.
Jay Siwek, a family physician from Georgetown University, practices at the Fort Lincoln Family Medicine Center and Providence Hospital in Northeast Washington.
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