How to Use Your Inhaler Correctly

Using your inhaler correctly is one of the most important skills you can develop when managing a respiratory condition. Even with the right medication, poor inhaler technique can significantly reduce the amount of medication that reaches your lungs. This guide provides clear, step-by-step instructions for using different types of inhalers, along with practical tips to help you get the most benefit from your medication.

Why Inhaler Technique Matters

Inhalers deliver medication directly to your lungs, where it can work most effectively. However, studies consistently show that many people do not use their inhalers correctly, even after receiving instructions from their healthcare provider. Poor technique can mean that less medication reaches your lungs, leading to reduced symptom control and potentially more frequent exacerbations.

Using your inhaler correctly is not about perfection — it is about developing a consistent, reliable technique that works for you. Taking the time to practice and have your technique checked can make a meaningful difference in how well your medication works.

Common errors in inhaler technique include:

• Not shaking the inhaler before use (for metered-dose inhalers)
• Breathing in too quickly or too slowly
• Not holding your breath long enough after inhaling
• Not coordinating actuation with inhalation
• Forgetting to use a spacer when recommended
• Not cleaning the inhaler regularly

Each of these errors can reduce the amount of medication that reaches your airways. The good news is that with practice and proper instruction, these issues can be addressed.

Types of Inhalers

There are several types of inhalers, and each has specific instructions for use. Understanding which type you have and how to use it correctly is essential for effective symptom management.

Metered-Dose Inhalers (MDIs)

Metered-dose inhalers are the most common type of inhaler. They use a small pressurized canister to deliver a measured dose of medication in aerosol form. MDIs require coordination between pressing the canister and inhaling. This coordination can be challenging for some people, which is why spacers are often recommended.

Key features of MDIs:

• Small, portable device
• Pressurized canister releases medication as a spray
• Requires coordination between actuation and inhalation
• Can be used with or without a spacer
• Contains a dose counter or indicator on many models

Dry-Powder Inhalers (DPIs)

Dry-powder inhalers deliver medication in a powder form that you breathe in. They are breath-activated, meaning they release the medication when you inhale. DPIs do not require coordination between actuation and inhalation, which can make them easier to use for some people. However, they require a fast and deep inhalation to deliver the medication effectively.

Key features of DPIs:

• Breath-activated — no need to coordinate actuation with inhalation
• Requires a fast, deep inhalation
• Does not use propellants
• Usually has a dose counter or indicator
• Should be kept dry and not washed

Soft-Mist Inhalers

Soft-mist inhalers are a newer type of inhaler that delivers medication as a slow, fine mist. The mist is released over a longer period than an MDI, making it easier to coordinate inhalation with the spray. This can be particularly helpful for people who have difficulty coordinating actuation and inhalation with traditional MDIs.

Key features of soft-mist inhalers:

• Delivers medication as a slow, fine mist
• Longer spray duration for easier coordination
• Can be used with a specific type of spacer
• Contains a dose counter or indicator

Step-by-Step Instructions for Each Inhaler Type

How to Use a Metered-Dose Inhaler (MDI)

Follow these steps to use your MDI correctly:

1. Prepare the inhaler: Remove the cap and shake the inhaler well for about 5 seconds. If you are using a new inhaler or one that has not been used for a while, prime it by releasing 1-2 test sprays into the air away from your face.
2. Breathe out completely: Sit upright or stand. Tilt your head back slightly and breathe out fully to empty your lungs.
3. Position the inhaler: Hold the inhaler upright with your index finger on top of the canister and your thumb on the bottom. Place the mouthpiece in your mouth and close your lips tightly around it.
4. Actuate and inhale: As you start to breathe in slowly and deeply, press down on the canister to release one puff. Continue breathing in slowly and deeply for 3-5 seconds.
5. Hold your breath: Remove the inhaler from your mouth and hold your breath for up to 10 seconds to allow the medication to settle in your lungs.
6. Breathe out slowly: Exhale slowly and completely.
7. Repeat if needed: If you need a second puff, wait about 30-60 seconds before repeating the steps. Shake the inhaler again before each puff.

Tips for using an MDI:

• Using a spacer can make MDI use much easier and improve drug delivery
• Practice the coordination of pressing and inhaling — it may take time to develop
• If you are having difficulty, ask your healthcare provider to watch your technique
• Clean the plastic housing of the inhaler regularly with warm water

How to Use a Dry-Powder Inhaler (DPI)

DPIs require a different technique than MDIs. Follow these steps:

1. Load the dose: Prepare the inhaler according to the device instructions. This may involve sliding a lever, turning a dial, or lifting a lid to load the dose. Do not shake the inhaler.
2. Breathe out completely: Sit upright or stand. Breathe out fully away from the inhaler to empty your lungs.
3. Position the inhaler: Place the mouthpiece in your mouth and close your lips tightly around it.
4. Inhale quickly and deeply: Breathe in quickly and deeply through your mouth. The device will release the medication when you inhale. You should hear the powder being released.
5. Hold your breath: Remove the inhaler from your mouth and hold your breath for up to 10 seconds.
6. Breathe out slowly: Exhale slowly and completely.
7. Close the inhaler: Close the device according to the instructions if applicable.

Tips for using a DPI:

• Do not exhale into the inhaler — this can blow the powder out
• DPIs should be kept dry — do not wash them
• Check the dose counter regularly to know when to replace the device
• If you are having difficulty, ask your healthcare provider to watch your technique

How to Use a Soft-Mist Inhaler

Soft-mist inhalers have a unique mechanism. Follow these steps:

1. Prepare the inhaler: Open the cap and insert the cartridge if it is not already inserted. Prime the device if you are using it for the first time or if it has not been used for several days.
2. Breathe out completely: Sit upright or stand. Breathe out fully to empty your lungs.
3. Position the inhaler: Place the mouthpiece in your mouth and close your lips tightly around it.
4. Press the button and inhale: Press the button to release the mist and at the same time, start breathing in slowly and deeply. The mist is released over a longer period, giving you time to coordinate your inhalation.
5. Continue breathing in: Continue breathing in slowly and deeply for 3-5 seconds.
6. Hold your breath: Remove the inhaler from your mouth and hold your breath for up to 10 seconds.
7. Breathe out slowly: Exhale slowly and completely.
8. Close the inhaler: Close the cap according to the device instructions.

Using a Spacer

Spacers are particularly helpful for people using metered-dose inhalers. They are also sometimes used with soft-mist inhalers. A spacer is a tube or chamber that attaches to the mouthpiece of your inhaler. It holds the medication after it is released, allowing you to inhale it at your own pace.

Benefits of using a spacer:

• Reduces the need for coordination between actuation and inhalation
• Increases the amount of medication that reaches the lungs
• Reduces the amount of medication deposited in the mouth and throat
• Decreases the risk of side effects like oral thrush

How to use a spacer:

1. Attach the spacer to the mouthpiece of your inhaler
2. Shake the inhaler and spacer together
3. Press the canister to release one puff into the spacer
4. Place the spacer mouthpiece in your mouth and seal your lips around it
5. Breathe in slowly and deeply for 3-5 seconds
6. Hold your breath for up to 10 seconds
7. Breathe out slowly
8. If a second puff is needed, wait 30-60 seconds and repeat

Tips for using a spacer:

• Clean your spacer regularly according to the manufacturer's instructions
• Do not use a spacer that is cracked or damaged
• Different spacers work with different inhalers — make sure yours is compatible

Inhaler Care and Maintenance

Taking care of your inhaler is essential for ensuring it works properly. Here are some general guidelines:

Cleaning Your Inhaler

• MDIs: Wash the plastic housing with warm water regularly. Remove the canister before washing and dry the plastic housing completely before reassembling.
• DPIs: Do not wash DPIs. They should be kept dry. Wipe the mouthpiece with a dry cloth if needed.
• Soft-mist inhalers: Wipe the mouthpiece with a dry cloth as needed.
• Spacers: Wash with warm water and mild detergent weekly. Allow to air dry completely before use.

Checking the Dose Counter

Most modern inhalers have dose counters that show how many doses remain. Check the counter regularly and know how many doses are left. Many inhalers need to be replaced when the counter reaches zero, even if there is still some medication visible.

Storing Your Inhaler

• Keep your inhaler at room temperature, away from extreme heat or cold
• Do not store your inhaler in the bathroom or near water
• Keep it out of direct sunlight
• Store it in a place where you can easily access it when needed

When to Replace Your Inhaler

• When the dose counter reaches zero
• If the device is damaged or not working properly
• If the medication appears to be blocked or not releasing properly
• After the expiration date has passed

Getting Your Technique Checked

Even if you have been using your inhaler for years, it is a good idea to have your technique checked regularly. Your healthcare provider, pharmacist, or respiratory therapist can observe your technique and provide feedback. This can help you identify and correct any errors that may have developed over time.

If you are having difficulty with your inhaler, don't hesitate to ask for help. There are often alternative devices or strategies that can make using your medication easier and more effective. Your healthcare team is there to support you in finding what works best for you.