Help Patients With Asthma Use Inhalers the Right Way

Joy Hsu, MD


April 18, 2016

Editorial Collaboration

Medscape &

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Hello. I am Dr Joy Hsu, with CDC's National Asthma Control Program. I am speaking to you as part of the CDC Expert Commentary Series on Medscape.

I would like to discuss the CDC response to clinicians' requests for tools to help their patients with asthma. More than 23 million people in the United States have asthma. Nearly half of those people with asthma do not have control over their disease. As clinicians well know, asthma cannot be cured, but it can be controlled if patients and their families understand and adhere to instructions from their healthcare providers.

Clinicians are the first to introduce people with asthma to correct ways to manage asthma. Clinicians provide a diagnosis, explain the disease, and guide patients through understanding asthma triggers, risks, and treatment. Patients and caregivers may not be able to process all of the information provided at an office visit. Patient adherence, and resulting asthma control, is dependent on what patients understand and remember from office visits. Studies have found that 40%-80% of medical information communicated by healthcare providers is forgotten immediately.[1]

Most clinicians have had the experience of a patient filling a prescription for medication and inhalers and then being unable to remember your instructions on exactly how to use the device. CDC's National Asthma Control Program developed How to Use Your Inhaler instructional videos and printable instructions as supplemental tools for clinicians to reinforce messages provided during office visits. The goal of these tools is to repeat the clinicians' messages once patients fill their prescriptions and have their inhalers in hand.

The videos and print instructions are designed to reach all people with asthma, including those with challenges in health literacy, limited or no sight, or hearing impairment. For those with limited or no sight, spoken instructions are provided in the videos. For the hearing impaired, the videos have closed captioning and detailed streaming text; also, video instructions are reinforced in illustrated and plain-language print materials. In response to CDC surveillance data, the materials were also created with targeted attention to the Spanish-speaking audience, which is disproportionately affected by asthma.

Clinicians can show the online videos in their offices and easily access and print or copy the written instructions to share with patients and families, or patients and families can get the information on their personal mobile devices or computers. These materials can also be used to share instructions with caregivers, school staff, daycare personnel, coaches, and others.

Three different methods of inhaler use are depicted, because healthcare professionals may recommend specific methods to different patients based on provider preference or patient skills and needs. These three different methods are:

  • Using a metered dose inhaler with a spacer;

  • Using a metered dose inhaler 1-2 inches from the mouth (without a spacer); and

  • Using a metered dose inhaler with the inhaler in the mouth.

Suggested Reading

Damon SA, Tardif RR. Asthma education: different viewpoints elicited by qualitative and quantitative methods. J Asthma 2015;52:314-317.

Labre MP, Herman EJ, Dumitru GG, Valenzuela KA, Cechman CL. Public health interventions for asthma: an umbrella review, 1990-2010. Am J Prev Med. 2012;42:403-410.

Orrell-Valente JK, Jones K, Manasse S, Thyne SM, Shenkin BN, Cabana MD. Children's and parents' report of asthma education received from physicians. J Asthma. 2011; 48:831-838.

Web Resources

Know How to Use Your Asthma Inhaler

How is Asthma Treated?

AirNow/EPA: Air Quality Notifications

American Academy of Allergy, Asthma & Immunology: Corticosteroids

American College of Allergy, Asthma & Immunology: Asthma Treatment

American Lung Association: Understand Your Medication

American Thoracic Society: Using Your Metered Dose Inhaler (MDI)

National Institutes of Health: Publications and Fact Sheets for Asthma Management from Guidelines for the Diagnosis and Management of Asthma (EPR-3)

Asthma and Allergy Foundation of America: What Do I Need to Know About Asthma Medicines

National Heart, Lung, and Blood Institute: Inhaled Corticosteroids to Keep Airways Open

National Heart, Lung, and Blood Institute: Physician Asthma Care Education

Joy Hsu, MD, is a Medical Officer in the National Asthma Control Program, Air Pollution and Respiratory Health Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health. Dr Hsu is a physician who is board-certified in internal medicine and allergy-immunology. Her peer-reviewed publications focus on asthma, allergy, respiratory health, and air pollution. Dr Hsu has a BA in linguistics from Stanford University; an MD from the University of California, San Francisco; and a master's in clinical investigation from Northwestern University.