How long do I wait between inhaler puffs?

How Long Do I Wait Between Inhaler Puffs?

The million dollar question. How long to wait between inhaler puffs? Like many asthmatics, medications by inhaler are an integral part of my everyday.  Also, like many patients, I am not always the most patient, patient. I think that I have mastered inhaler technique administration and I  know that there are changing theories on  which inhaler to take first and visa versa. I sought out on a mission to investigate this further.

Starting at the beginning, making sure things are primed.  If your inhaler is an MDI it is important that it is primed and ready to go. Priming is essentially means that you spray medication into the air, to make sure it is ready to come out. The Firestone Institute for Respiratory Health recommends that you wait 30 seconds before each spray when you are priming.1

Here is a handy dandy chart that looks at priming inhalers from the folks at the Firestone Institute for Respiratory Health.2

Name of Medication How to Prime
Airomir 4 sprays if new or not used in 14 days
Alvesco 3 sprays if new or not used in 7 days
Atrovent 2 sprays when new and I spray if not 3 days
Flovent 1 spray if new or not used in 7 days
QVAR 4 sprays if new or not used in 14 days
Ventolin 4 sprays if new or not used in 28 days

Now that your inhaler is primed, which one do you take first?

The data and research are still up for interpretation, however I know that my health care team had recommended that I take my bronchodilators first, this recommendation was also a long time ago and may now be outdated. In fairness, I have not yet asked my care team this question directly, I am slightly embarrassed that I am already supposed to know this information

In my research, I came across information from the Asthma Partners group that indicates that they have modified their recommendations and are no longer suggesting that patients use a bronchodilator first. The thought was that the bronchodilator would open the bronchial tubes, allowing the anti-inflammatory medication to penetrate deeper into the lungs. They found that patients were going to need to wait the 5-10 or more for the beta-agonist to work fully before they could move on to an anti-inflammatory and that this was impractical. Finally, people realize that some things are impractical for patients.3 Hoorah! They also found that the bronchial tubes were indeed open sufficiently to deliver anti-inflammatory medication without pre treatment. It is important to note that what one center recommends, may not be what your doctor recommendations. Please check with your care team before making any adjustments.

How long do you wait before taking puffs of your inhaler?

There are recommendations that if you use an inhaler in rapid supersession that you could without any pause, that it may deliver medication erratically. It is thought that this may be due to cooling taking place at the metal nozzle of the canister, which might interfere with the precise functioning and exact delivery. It is thought that slow inhalations, followed by brief breath-holding should be sufficient. It looks like the theories about holding for a minute between inhalations are being replaced as more data becomes available.4

I suspect that patients could see more changes in these theories as more research is conducted. Till then, I will keep an eye on my technique and will be mindful of bad rapid succession habits.

 

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