How to Use an Inhaler Correctly: Step-by-Step Guide

7 min read · Medicines · By the Asthra Health Care team

Why inhalers are the preferred choice

Inhalers are the main treatment for asthma and COPD. They send medicine directly into the airways, so a much smaller amount works faster and with fewer side effects than tablets or syrups. Many people in India still worry that inhalers are addictive or only for serious cases. This is a myth. Inhalers are safe, not habit-forming, and often the most effective way to keep breathing problems under control.

Relievers and controllers

Reliever inhalers, such as salbutamol, open tight airways within minutes and are used when symptoms flare. Controller or preventer inhalers, usually containing an inhaled steroid, sometimes with a long-acting bronchodilator, reduce swelling in the airways and prevent attacks when used regularly. Your doctor decides which inhalers you need and when to use them.

Inhalers containing steroids and other controller medicines are used only on a doctor's prescription. Do not stop a controller inhaler just because you feel well; ask your doctor first, as symptoms may return. Many people with asthma need a controller every day even when they have no symptoms, because the airway swelling is still present.

Using a metered-dose inhaler (MDI)

A metered-dose inhaler is the common 'puffer' that sprays a measured puff of medicine. The biggest mistake is pressing the canister and breathing in at the wrong time, so most of the medicine hits the throat instead of the lungs. Follow these steps, or the leaflet for your device.

• Remove the cap and shake the inhaler well
• Sit or stand up straight and breathe out gently, away from the inhaler
• Seal your lips around the mouthpiece
• Start breathing in slowly and press the canister once at the same time
• Keep breathing in slowly and deeply, then hold your breath for about ten seconds or as long as comfortable
• Breathe out gently; if another puff is prescribed, wait a short while and repeat

Why a spacer helps

A spacer is a plastic tube that fits onto a metered-dose inhaler. You spray the puff into the spacer and then breathe it in from the mouthpiece, so there is no need to coordinate pressing and breathing. More medicine reaches the lungs and less stays in the mouth. Spacers are especially useful for children, elderly people and anyone using a steroid inhaler. Young children use a spacer with a face mask.

Using a dry powder inhaler

Dry powder inhalers include capsule devices and multi-dose discs. They release medicine when you breathe in quickly and deeply, so they need a strong breath and do not work well with a spacer. Never breathe out into a dry powder inhaler, because moisture can clump the powder and spoil it.

For capsule devices, load one capsule, pierce it as instructed, breathe out away from the device, then breathe in fast and deep. Check that the capsule is empty afterwards. Capsules are meant for the device only and must never be swallowed.

Common mistakes to avoid

Studies of inhaler use around the world show that incorrect technique is very common, and most people do not realise they are making mistakes. Small errors can mean the medicine does not reach the lungs, leading people to think the inhaler does not work or that they need a stronger medicine.

• Not shaking a metered-dose inhaler before use
• Breathing in too fast with an MDI, or too slowly with a dry powder inhaler
• Not holding the breath after inhaling
• Using an empty inhaler; check the counter or ask your pharmacist how to tell
• Not rinsing the mouth after a steroid inhaler

Care, cleaning and side effects

After using a steroid inhaler, rinse your mouth with water and spit it out to reduce the risk of oral thrush and a hoarse voice. Clean the plastic holder of a metered-dose inhaler as the leaflet advises and let it air-dry. Keep inhalers away from heat, direct sunlight and moisture. Reliever inhalers can cause a fast heartbeat or slight shakiness for a short time, which usually settles.

Special groups and checking technique

Children, elderly people, pregnant women and people with heart disease can usually use inhalers safely, but the doctor chooses the right device and medicine. Pregnant women with asthma should not stop their inhalers without advice, because uncontrolled asthma is itself a risk to mother and baby.

Take your inhaler and spacer to every appointment and ask your doctor or pharmacist to watch you use it. Technique often slips over time, and a few minutes of checking can make your treatment work far better. Also ask for a written action plan that explains what to do if symptoms worsen. If you have any doubts about your inhaler, consult your doctor or pharmacist.

This article is general health information, not medical advice. Do not start, stop or combine medicines on your own — always follow your doctor's prescription and ask your pharmacist if unsure.