Seattle Times: “Very Few Use EpiPen, Asthma Inhalers Correctly”

Originally published Wednesday, December 17, 2014 at 9:00 PM

Study: Very few use EpiPen, asthma inhalers correctly

EpiPens and inhalers can stop life-threatening allergic reactions or asthma attacks, but too few people use them correctly, a study finds. Seattle doctors and parents agree. 

By JoNel Aleccia

Seattle Times health reporter

Faced with a life-threatening allergic reaction or asthma attack, many people reach for an EpiPen or inhaler to stop the emergency. But a new review finds that too few actually use the devices correctly. 

Just 16 percent of patients used epinephrine injectors the right way, while only 7 percent used asthma inhalers as intended, according to researchers at the University of Texas Medical Branch in Galveston. 

“We were pretty surprised,” said Dr. Rana Bonds, the allergist who led the research published Wednesday in the Annals of Allergy, Asthma and Immunology. “We send patients out with these devices that can save their lives and they don’t know how to use them.”

Those findings ring true for Seattle doctors and parents, who say that concerns about using the devices loom large in the community where many children — and adults — suffer from potentially fatal food allergies and asthma. 

“That has been an age-old problem,” said Dr. Stephen Tilles, of the Northwest Asthma & Allergy Center. “It’s a very basic treatment assumption, and it is an incorrect assumption, in many cases.”

Heather Black, 41, a Seattle mother of a 5-year-old son with severe allergies, said uncertainty over using EpiPens is common among members of the Washington chapter of No Nuts Moms Group, a support organization. 

“I would say at least 50 percent of the moms aren’t positive they’ll do it successfully,” said Black, an organizer. 

When Black’s own son, Nate, suffered a scary allergic reaction 18 months ago, she knew what to do only because she’d just seen a YouTube video on the subject. 

“I knew I had to administer it in the thigh, and I knew I had to hold it there for 10 seconds,” she said. “Instinctively, I would have put it in his thigh and pulled it right out.”

Indeed, the Texas researchers found that the most common error with the EpiPen — one type of device that uses medication to reverse allergic reactions — was not holding the unit in place for 10 seconds after triggering. Of the 102 adult patients in the study who used epinephrine injectors, three-quarters made that mistake, researchers found. 

With inhalers, which contain medication that improves the ability to breathe, the most common problem was not exhaling completely before using the device, which could limit the amount of medication dispensed. Of the 44 patients with inhalers, two-thirds missed this step.

The limited number of patients in the review means this isn’t the last word on EpiPen and inhaler use, noted Dr. Wendy Sue Swanson, a Seattle Children’s pediatrician who writes the Seattle Mama Doc blog. But, she added, it’s a useful reminder. 

“This is a very small, observational study that says, ‘Gosh, we’re not perfect at using these in emergency situations,’ ” she said. “This is just a spark to say we have to have better education at the time we dispense about how to use these.”

It’s an issue that affects a lot of people. As many as 15 million people in the U.S. have food allergies and about 25 million have asthma, according to the Centers for Disease Control and Prevention. 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, the CDC said. Using the devices incorrectly could have dire results, the researchers found. The EpiPen users who made mistakes would not have benefitted from the potentially lifesaving drug. Inhaler users would have received some of the drug, but less than the optimal amount. 

Even worse, though, is not using a device like an EpiPen at all, said Dr. David Jeong, head of the asthma, allergy and immunology section at Virginia Mason Medical Center in Seattle. 

“There’s a greater risk of having a reaction and not using the epinephrine,” he said. “There’s no harm in using it.”

The key is preparation and practice, Jeong added. He uses training devices to get patients used to the weight of the EpiPen, the “click” when the drug is dispensed.

“We really get hands-on and teach them in the office,” Jeong said. “I ask them, at least once or twice a year, remind yourself how to use it.”

JoNel Aleccia: 206-464-2906 or jaleccia@seattletimes.com. On Twitter @JoNel_Aleccia