I would like to add another major error to those cited in “Inhalation therapy: Help patients avoid these mistakes” (J Fam Pract. 2011;60:714-720): Patients often shove the mouthpiece into their mouths, which prevents them from getting a good inhalation.
I demonstrate to patients that just pursing your lips loosely around the mouthpiece and inhaling allows air from around the mouthpiece to enter, increases the airflow, and moves the medication farther into the lungs.
The Food and Drug Administration should mandate that all metered-dose inhalers (MDIs) come with a built-in spacer. This would greatly improve compliance—especially among elderly patients, who often have difficulty using MDIs properly. For a few cents each, thousands of dollars could be saved by a reduction in patient visits to emergency rooms.
David Lubin, MD
Tampa, Fla