Ah, yes.  The instructions.  One of those Venus and Mars examples: women read them, men blunder ahead without them.  But even with written instructions, results are not always assured.  Just ask anyone trying to assemble a Swedish bookshelf with an Allen wrench, a bag of metal pieces and instructions in twenty languages other than your own.  To make matters worse, it seems there is always one missing Umvaart. 

But sometimes instructions are a matter of life and death.  A case in point is with emergency self-injections of adrenaline, and with puffers for acute asthma attacks.

epi pen

A recent US study shows a dismal 16% rate of correct usage of prescribed adrenalin auto-injectors, like the EpiPen. If someone is highly allergic to something, such as a bee sting or foods such as peanuts or shellfish,  then swift and proper injection of adrenaline is lifesaving.  Common errors include not pushing down forcefully enough to have the needle tip penetrate through the skin, or not holding  the device in place for at least 10 seconds.  Not to mention forgetting to carry it with you on that canoe trip.

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For acute asthma, where one expects to have a greater frequency of crises than food allergies, the error rate for puffers was even worse.  Only 7 % of asthma sufferers could use their puffers properly, according to the Annals of Allergy, Asthma and Immunology. 

The leader of the study, Dr. Rana Bonds from the University of Texas Medical Branch, notes that people were not trained properly in the first place, and/or “forgot the instructions over time”.   Similar studies show the problem is universal around the world.

Apart from the obvious personal distress, the financial consequences are immense.  Asthma medications constitute literally billions of dollars of expense, and if most of it is squandered, then our tax and insurance dollars are being wasted. 

So here is how to use the epipen:


For video demonstration of the epipen use: 

And here is how to use your inhaler for asthma:


For video demonstration of your inhalers:

And for the use of an inhaler with the spacer, please review this video:

One last point about the inhaler, it would make far greater sense to extend the neck into a straight line, rather than expecting the inhalations to bend around a 90 degree corner to get from lips to lung.  Just as the sword-swallower at the circus knows, along with the bronchoscopy surgeon in the operating room, you need a straight line to get a straight shot.  That’s not in the instruction manual, just one of my own observations.

Be sure to discuss with your pharmacist as well, in case any different brand or model is being substituted, there may be a new set of instructions to review. 

As a precaution, remember to carry a spare.  Just like propane tanks for that big weekend bbq, inhalers are hard to check for remaining capacity.  Also remember to check stale dates, as there is no point  trusting your life to an out-of-date product. 

Please make sure you check regularly with your doctor, and follow any instructions for additional testing, monitoring, or changes of strategy. 

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