5 Reasons Your COPD Inhalers May Not Be Working

Photo Credit: Glow/Glow Wellness.

Are you puffing and puffing on your inhalers but not feeling or seeing any benefit? Many patients may take this as a sign that the medication isn’t working. But before throwing out your inhaler in frustration, consider these five simple (and potentially fixable) problems when using inhaler medications.

  1. New delivery mechanisms. Nowadays there are dozens of different inhaler devices, all of which have slightly different mechanisms in the inhaler apparatus. Some devices require you to push down on the medication vial while inhaling at the same time (e.g. Proair, Ventolin, Combivent). Some come as a disk that requires you to flip a switch to ‘load’ the device, and then inhale the medicine (Advair, Flovent). Still others have a twist mechanism (eg. asmanex) and still others require you to drop a pill into the inhaler, pierce it by using a button, and then inhaling (Spiriva). With so many devices, it’s easy to get confused about how to use the different kinds of inhalers. Even though you may THINK you’re using it correctly, it never hurts to ask your pharmacist or physician to observe you while you take the medication. Sometimes a very simple error in device use can be responsible for an inhaler medication’s lack of effect. 
  1. Technique Issues. Many patients have problems using inhalers correctly when they involve pumping the vial and inhaling simultaneously. If you don’t inhale at exactly the right moment, the medicine may not get into your lungs and instead, the mist bounces around in the mouth until seeping out into the air. This is a common reason why medications “don’t work”…when in fact, the medicine isn’t being delivered into the lungs at all. For those who have trouble with the timing of inhalers, other kinds of inhalers that don’t require this kind of coordination may be helpful (such as a discus). Alternatively, spacers or nebulizers can help to eliminate the need for the coordination of pumping and inhaling. It’s extremely common for patients to think they are getting a full medication dose, but in fact, they are not. Ask your doctor to watch you use your inhaler to get feedback about whether you are using it correctly. Click here for more tips on inhaler techniques.
  1. Big tongue or tonsils. Sometimes, the problem is simple anatomy. If you have a big tongue or tonsils, the medication may get ‘blocked’ from going down the airway. In this situation, deep, slow inhalations can help to move the palate out of the way to help the medication travel into the airway. Sometimes the extra concentration on getting the medicine into the lungs is all that is needed to overcome this problem.
  1. Forgetting to hold your breath. Once the medication gets into the lungs, it needs to have a moment to absorb. Proper inhaler technique involves starting out by exhaling fully, putting the inhaler to your lips, then starting a deep and full inhalation. But here’s the important part: hold your breath as long as you can before exhaling. This will allow the medication time to absorb into the airways and provide its full effect.
  2. Using the inhaler at the wrong time.  Some inhalers are meant to be used once a day and others are meant to be used in an emergency (such as albuterol). For some patients, using an albuterol inhaler immediately before exercise or exertion can help to prevent shortness of breath, but if taken after the exercise, it might not be as effective. Albuterol inhalers can be even more effective when taken 5 minutes before exertion so that the airways are nice and open to absorb the medication.

The Bottom Line

Before you pitch the inhaler into the trash, be sure to show your doctor and/or pharmacist how you use the medication. Even though you may have used inhalers your whole life, small differences in one brand over another may account for a perceived lack of effectiveness.

It could be that the medication simply doesn’t work for you, but before giving up, talk about inhaler technique and the tips above to make sure that there isn’t a way to give it one last shot.

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