I'm Not an Actor, and I Don't Play One in the Office

September 2, 2010
David Lubin, MD

Most asthma patients don%u2019t know how to properly use an inhaler, according to Dr. Lubin, who describes a rather unique technique one patient had.

I’ve thought about it, though. I’ve thought about letting my beard grow a bit, and bringing a cane and a bottle of Vicodin to the office on Mondays and portraying Dr. House. Don’t take your BP or cholesterol meds and I snarl sarcastically in your face, “Do you just wanna die despite my best efforts to prolong your life?!?”

You might have seen this clip online: Dr. House asks a patient to show him how she uses her asthma inhaler and she proceeds to spray herself as if it’s an atomizer. He just stares at her in bewilderment.

I had a similar patient this week. Her asthma was acting up and the inhaler wasn’t helping. I asked her to show me how she used it. I then saw a technique unlike anything I have ever seen in 34 years of practice. She turned it upside down, whereupon I immediately stopped her and explained she would have to invert it to get the medicine out. She then proceeded to spray the inside of her mouth without inhaling, and that was it. I imagined popping a Vicodin and beating her with my cane, but instead I just sat there, shook my head, and decided that just wouldn’t be right.

I went to the drug closet and found her a spacer and showed her how to use it, thinking that after some practice, she’d actually feel better. The FDA is lax in not getting pharmaceutical companies to attach a small spacer to the aerosol inhalers. Most patients just can’t use the inhalers properly.

Another minor dilemma is cropping up. Patients are losing their jobs and insurance and can’t afford to come in, but are calling to refill blood pressure prescriptions. As much as I’d like them to come in, especially when their pressure has not been controlled, I feel morally obligated to at least call in their prescriptions. I know things are tough all around and there’s no sense in making it even worse.