The Importance of Counseling on Inhalers

This week at the pharmacy a woman came in all upset, so upset that she could hardly tell us what was going on. When we finally helped her to settle down, she let us know that she had just gotten off the phone with the Poison Control Center. She stated that she didn't believe what they had told her and wanted a confirmation from the pharmacy staff. This right here shows how much patients use pharmacist as one of their first sources for drug information and knowledge. They trust their pharmacists as much if not more than their doctors. Her concern was that she had just recently been prescribed a Spiriva inhaler, and she had swallowed the capsule that comes with the handihaler. How Spiriva works, is you take the capsule and insert it into the handihaler that comes with the 30 capsules. You put it into the center holder and then close the lid, and wait for a clicking noise. This will puncture the capsule which will then release the powder that was held within the capsule. This releases the powder, and the patient should then breathe out, hold the handihaler vertical to their mouth and breathe in slowly and deeply. This will then cause a vibrating and spinning noise within the machine, moving the capsule shell and inhaling the powder. Hold you breath for ten seconds and then breathe out. Also if you then look inside the container and there is still powder remaining within, you should breathe in a second time to try and get the remaining contents as well. Then open the lid, discard the capsule shell, and clean out the handihaler.

These are all counseling points that should be told to the patient when they're receiving their handihaler for the first time, because patients will not necessarily understand how these devices work. All inhalers work differently, there are metered dose inhalers, breath actuated inhalers, nebulizers, and dry powder inhalers. So being sure to counsel your patient on these different types of devices is very important. Active learning when counseling patients about their inhalers is very important, and can actually determine how well they understand what you're telling them. Instead of just telling them the specifics of how to use the inhaler let them hold the device themselves and walk through the motions. This will better help them remember what they've just learned. The same can be said for other medical devices as well, such as blood glucose meters, lancing devices, nebulizers, breast pumps, nuvarings, suppositories, and other medical delivery systems that stray from the usual tablet or capsule.

Had this patient receiving more in depth counseling she would have known not to swallow the capsule, and to use it properly, avoiding the wasted time, and the scare that she received wondering if she'd be okay after swallowing the capsule. The lesson here is to make sure that we never assume that patients understand how their medications work/should be taken just because they say they do, many times they just want to get out of the pharmacy as fast as they can, or don't want to feel uncomfortable or illiterate if they don't understand. So making sure to just go through this with them is very important, and can save them trouble in the long run.