It’s the holiday season with holiday parties, get-togethers and travel plans. Among the more common things I see in the ER during this season are food allergies and asthma episodes. I often see patients who have run out of medications, or who travelled without their medical devices such as the epipens (epinephrine autoinjector) and inhalers, or who used their medications but saw no improvement.
According to the Centers for Disease Control and Prevention, as many as 15 million people in the U.S. have food allergies and about 25 million have asthma; about 125 people die each year from food-induced anaphylaxis, the most severe outcome of a food allergy, while more than 3,300 die as a result of asthma. Physicians are giving parents and patients prescriptions for these lifesaving medications but are they being clear and detailed with the instructions? Are the families asking enough questions about the proper use of these devices? Are the kids who are instructed to use these medications being given proper training?
An alarming study from the University of Texas Medical Branch in Galveston in January’s edition of the Annals of Allergy, Asthma & Immunology, indicates that a majority of patients often do not use these devices correctly, resulting in less effective delivery of asthma and allergy medications.
Allergic reactions and asthma are definitely conditions where proper technique and timely administration of medications can make a huge difference in the outcome and can be lifesaving in many instances. Incorrect use of the epipens in severe allergies, and inhalers during asthma attacks, can keep patients from getting the medication they need to prevent disastrous outcomes. The study indicated that only a meager 16 percent of patients used epinephrine injectors the right way, while only 7 percent used asthma inhalers as intended. The study looked at more than 145 patients with allergy/asthma and who use epinephrine auto injectors or inhalers.
With the use of epipens, the most common error patients made was holding the device in place for at least 10 seconds after triggering the injection. Other documented errors included not placing the “active” end of the autoinjector on the thigh, and not exerting enough force to trigger the injection.
With the patients who used asthma inhalers, only 7% used the device correctly, while 63% missed at least 3 steps, the most common being not completely and forcefully exhaling before administering the medication. The next most common misstep was not shaking the inhaler before taking a dose. Age, education level and family history did not impact a patient’s likelihood to use the device correctly.
Asthma and anaphylaxis can be fatal, especially if the medications are not given soon enough and with correct use of the medical devices. A little extra effort and time spent by physicians to teach, and the patients/families to learn, the correct techniques and getting hands-on practice with these devices can go a long way in the outcome of these conditions and can potentially save lives. Click here for a series of instructional videos on the proper use of asthma inhalers.