Puffing

The first Monday of the month and the last Monday of Respirology.

Actually, I quite like Respirology. The consult service is busy, but I have legitimately learned a lot and am now less afraid to mess (constructively) with people’s puffers when they are admitted to me in the future.

I also quite like Medical Mondays. Check out other medically affiliated blogs at the link on the image below.

Since it is the second to last day of resp, I thought I would share this lovely image.

Image from pinterest.com.

I remember seeing this episode and laughing hysterically.

It is so true.

People have no clue how to use their puffers. And they think they do. And they often can’t figure out why they aren’t getting better. But it is often because something isn’t being done right. And often this is because nobody asked and nobody taught.

I know this from both sides of the hypothetical office.

I have been on puffers off and on since I was about 9. I am one of those weirdos that did not have childhood asthma in the wheezy since toddlerhood kind of ways. I developed asthma in my late kid years.

I finally gained control of my asthma when I was in my 20s.

I have CONSISTENTLY PROPERLY used my puffers never.

Okay, never isn’t a fair term. I have used them consistently and properly, but not for more than a few months at a time.

I had a puffer for the odd “chest infection” as a tween. I never had an aerochamber. We figured out how it worked by reading the instructions.

One time, I was prescribed a turbuhaler. That is a puffer that has a powder you suck in. There is no puff of aerosol. We couldn’t figure out why we couldn’t taste or see it (this is before the days of Google, boys and girls), so I took a good 20 hits of puffer before we figured it out.

Google would have shown me this… Instead of just the words on the tube. And helpful tidbits like you shouldn’t taste or see anything. Image from theasthmacenter.org.

I was first given an aerochamber at 14. By this point, my breathing issues were beyond asthma and got into this weird laryngeal spasm thing, so that not only did I wheeze, but I had stridor because I didn’t keep my airway open right any more for some reason that is still beyond me (and probably at least partly psychosomatic).

What 14 year old who audibly wheezes and hacks wants to add to her awesomeness by carrying an aerochamber everywhere?

Not this one.

So, I used it at home and no where else.

It took years of titrations, allergy shots and finally growing up enough to see the greatness of not being sick all the time to finally establish good asthma control. If I had actually used the darn puffers properly all the time, it might have been quicker. Maybe not because there was other stuff at play, but maybe.

Instead, I would take them until I felt well, then I would forget them most of the time until got a cold, which would then linger forever because my airways hated me. That is when I would start taking them properly again.

Now, I have an action plan. I have that figured out with lots of medical education, doctors orders and real experience.

I don’t always follow it. I miss days of my steroid inhaler sometimes. That usually comes back to bite me. I forget to restart my seasonal asthma/allergy medication when Spring comes (seriously, I just realized this now). My aerochamber (that I have had for an indeterminate period of time) has a crack in it (I will get a new one next time I see the doctor), so I confess, I haven’t been using it. And I also confess I never carry it with me.

So, if I, the doctor suck at managing my respiratory illness, I know that  most patients are probably kind of like me too. That being said, I think it is doable.

I mean, it is where your priorities are at…. Breathing is good. The problem is that when you feel good and a problem doesn’t flare that instant, you don’t always think (for instance, I would never skip my migraine prophylaxis because 1 or 2 missed doses and I am out for the count for a day).

What I am pointing out is that puffers are inconvenient. Moreso than taking a pill. If you have an aerochamber, they are bulky, need to be washed and don’t fit in a nice purse (especially if you are me and like to carry a book).

The directions for puffers are variable. Often, I see people who don’t understand why their directions are different from the ones on the bottle and different from their friend. They get mixed up. People don’t understand that one is to keep you well long term and another is for emergencies only.

And don’t even get me started on proper use.

One of the docs I work with said that he suspects 75% of people prescribed puffers don’t use them properly. Mind you probably 20 or 25% of those people don’t use them properly because they don’t actually need them (that is a rant for another day). I’d believe it.

Today, I saw someone grab their puffer from their bedside table and try to use it without the aerochamber with me, the resident working for the lung specialists, standing right there!

I put it together and showed her how it worked. She had never seen it used that way before. Mind you, it had a mask because this person had such bad respiratory distress taking a single deep breath and holding for 10 seconds was out of the question. But, until then, that is what the person tried to do, but couldn’t do.

Image from asthma.ca

That is why I ask how you use your puffers.

Because I don’t always do it right, but I want you to do it right. I like it when people show me up and do everything to a tea and rattle off the proper timing and dosing. But, when you don’t know, I show you.

You can’t get better if you don’t get appropriate drug.

That message is as much for me as it is the other millions of people with respiratory disease.

But seriously, if you would up here looking for advice on how to take your puffer… GO SEE YOUR DOCTOR!

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14 thoughts on “Puffing

  1. Stopping by from MM. We had a mini session on how to use and teach others to use inhalers in our course. At first we didn’t realize how many people misunderstand or ignore directions. We got to play around with saline inhalers and give each other directions on how to use them .

    • That is really neat to have a session teaching people to use inhalers. We just learn it on the fly, but I am glad that I had the background where I already kind of knew what to do with them.

  2. The turbuhaler??? “That is a puffer that has a powder you suck in.” Something about sucking a powder down into your lungs just sounds plain wrong… Made me cough just reading about it! LOL!

    • The powder dissolves almost instantly and you don’t feel it. I’ve used Ventolin Rotacaps (dry powder albuterol, unfortunately not made anymore) and currently use Spiriva. A dry-powder inhaler has no strong irritant/carcinogen such as ethanol (used in Proventil HFA). Not much of an issue for me anymore since I usually use a nebulizer.

      I’ve never had a doctor attempt to show me how to use an inhaler. In my experience, they usually don’t know how and maybe haven’t even opened the box to look at it.

      I’ve met several older people who were intimidated by the entire process and needed careful coaching to get the timing right and ease their anxiety about the medication. So for some people it’s not just carelessness – they need extra support.

      • I like the dry powder inhalers for that very reason, although they don’t work well if people don’t have the lung function to suck. Plus they require less equipment. 🙂

        Interesting that you have never had a doctor attempt to show you how to use an inhaler. That being said, it doesn’t surprise me. They were surprised I knew how to use them properly when I started my Respirology rotation. But, because people are intimidated and because it isn’t exactly an instinctive skill, that is why someone should be showing people how to use them. And following up to make sure they are still using them properly.

  3. During our Internal OSCEs, apparently if you’re floundering and doing REALLY badly, they give you puffers as a pass/fail question. Apparently very few medical students pass that question because they don’t pay enough attention to learning how to use it – kind of shocking. And that’s just the technique. I’m really glad I’ve never had chest problems myself. I would probably be hugely non-compliant.

  4. Thanks for linking up with Medical Mondays! I love House, but somehow missed that episode…. I am going to have to go back and find it because the picture version is hilarious.

    • Thanks for hosting MM, as always!
      Check out the episode. It is one of the walk-in clinic scenes and was more of a comedic relief moment than the actual plot line, but it was funny.

  5. Stopping by from MM – I was prescribed a puffer ions ago in middle school when I had walking pneumonia. Pretty certain I never used it right the few times I did when continuing to play basketball, whoops.

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