Inhale – but do it right!

Theory and practice of inhalation therapy

For inhaled medication to be effective, a sufficient amount must reach the bronchi. Various physical mechanisms are involved in this process. Impaction describes the collision of inhaled particles with branches in the bronchial tree, preventing them from penetrating the deeper lung regions. Similar to how a car can be thrown off course and crash into a guardrail or tree when the driver is speeding, impaction in the airways also depends on the inhalation speed. Therefore, the optimal inhalation speed is crucial for effective inhalation. This varies depending on the inhalation system used. Generally, it is beneficial to inhale slowly, deeply, and steadily. For metered-dose inhalers, a low airflow of 20 liters per minute is sufficient. This is much less than most patients expect.

In practical everyday use, the position of the head during inhalation is important. Tilting the head back slightly, as when drinking, opens the airways in the throat more widely and makes the curve less constricted, allowing the medication to pass through more easily with the inhaled airflow. Attention must also be paid to the tongue and teeth. Place the mouthpiece between your lips, keeping your teeth loosely separated without biting down on the mouthpiece. This also keeps the tongue resting loosely on the floor of the mouth. It is crucial that the tongue is not pushed upwards towards the palate, as this would narrow the airway during inhalation. Another physical principle is sedimentation. This describes the process by which inhaled particles settle in the lungs. The size of the particles, their density, and their density play an important role in this process. To ensure good sedimentation, hold your breath for several seconds after inhaling and pause before exhaling. This allows the inhaled medication to settle effectively in the bronchi. Significant progress has been made with inhaled antibiotics. Particles have been developed that resemble hollow, perforated spheres and, due to their low density, can therefore penetrate particularly well and deeply into the lungs. In recent years, inhalation systems have been continuously improved, allowing more medication to reach the lungs. Nevertheless, even with new dry powder inhalers, less than 40 mg of the nominal dose actually reaches the lungs.

The Kata-App® offers excellent support, a digital tool for more precise and effective inhalation therapy.

Moist inhalation

Inhalation therapy with electric nebulizers is not as easy for patients to use as it might seem. If the patient inhales and exhales too quickly and forgets to pause, dynamic hyperinflation can occur, making the inhalation difficult for them to tolerate. It is better to briefly interrupt the mist using a pause button. A PEP (post-exposure prophylaxis) system attached to the nebulizer is particularly beneficial, as it promotes prolonged exhalation. Special attachments even allow for oscillation, which helps to loosen thick bronchial secretions.

Metered Dose Inhaler

Proper inhalation technique is particularly important for metered-dose inhalers. In one study, a slow inhalation rate of 30 l/min resulted in 15 µT of the drug being deposited in the lungs, while a too-rapid flow rate of 80 l/min resulted in only 8 µT. The speaker generally advises always using a spacer with a metered-dose inhaler. This has two major advantages: it allows for a slow inhalation, and it eliminates the need to coordinate inhalation with triggering the dose. Those using inhaled corticosteroids should use them before breakfast and before dinner. Eating and drinking then help to reduce the amount of the remaining medication in the inhaler. Cortisone It washes away anything still in the mouth and throat. This reduces the risk of side effects such as hoarseness or oral thrush.

Powder inhaler

Powder inhalers are available for a wide variety of medications. These differ in their internal resistance, flow rates, and handling. Typically, the medication is bound to lactose (milk sugar). It must be separated from this carrier during inhalation. Therefore, you need to inhale more quickly with these devices than with metered-dose inhalers, achieving flow rates of 60-80 liters per minute. If you breathe too gently, the medication cannot detach from the carrier. If you inhale too forcefully and quickly, most of the medication remains in the throat instead of being inhaled into the lungs. Coughing is then a common side effect. Powder inhalers offer varying degrees of resistance to inhalation. Depending on the device, you therefore need to exert varying amounts of effort to achieve the same flow rate. The medication for inhalation is packaged in gelatin capsules. Gelatin becomes slightly sticky when it gets wet. Therefore, you must never exhale into the device. Storing the powder inhaler in the bathroom or cleaning it with a damp cloth should also be avoided. The capsules must not be pushed out of the blister pack like tablets, as this could crush the soft capsule. Instead, first remove the aluminum foil and then let the gelatin capsule slide out.

Prescribing and patient education

It is generally said that only a third of medical advice is taken seriously and followed correctly. The doctor must create a precise treatment plan and discuss it with the patient. Step-by-step instructions are helpful, as is... The videos on proper inhalation from the German Respiratory League. Thorough and repeated patient training is essential to eliminate any application errors. Consistent practice is helpful, ideally with a respiratory therapist.