How to take your inhaler correctly? The Ultimate Guide for All Types

Studies show a significant percentage of inhaler users have improper technique, leading to reduced medication effectiveness. Learning how to take your inhaler correctly is a crucial step toward better managing respiratory conditions like asthma and COPD and ensuring the medicine reaches deep into your lungs where it's needed most.

Quick Summary

This guide provides step-by-step instructions for using metered-dose and dry powder inhalers, with or without a spacer. It details common errors to avoid, offers a comparison of different inhaler types, and covers essential cleaning and maintenance tips.

Key Points

• Shake MDIs, not DPIs: Always shake a metered-dose inhaler vigorously before each use, but never shake a dry powder inhaler, which can cause the powder to clump.

• Inhale correctly for your device: Use a slow, deep breath for an MDI and a quick, forceful one for a DPI to ensure proper medication delivery.

• Use a spacer for MDIs: Spacers are highly recommended for MDIs to improve medication reaching the lungs and prevent it from settling in the throat.

• Hold your breath: After inhaling, hold your breath for up to 10 seconds to allow the medication time to settle deep into your airways.

• Exhale away from the device: Always breathe out completely away from the inhaler before taking a puff to make room in your lungs for the medication.

• Rinse with water after steroid use: If your inhaler contains a corticosteroid, rinsing your mouth and gargling with water after each use helps prevent oral thrush.

• Clean regularly: Clean the plastic components of your MDI weekly with warm water and air-dry, while only wiping DPI mouthpieces dry to prevent clogging.

The Importance of Correct Inhaler Technique

Proper inhaler technique is foundational for effective respiratory disease management. When used correctly, these devices deliver medication directly to the lungs, reducing inflammation and opening airways. However, improper use can result in a large portion of the dose settling in the mouth or throat, limiting its therapeutic effect and increasing the risk of side effects, such as oral thrush, especially with corticosteroid inhalers. Mastering your device's specific technique is vital for achieving the best possible health outcomes.

Using a Metered-Dose Inhaler (MDI)

An MDI, often called a "puffer," delivers a measured dose of medication as a fine spray. The technique varies depending on whether you use a spacer.

MDI Technique (without a spacer)

1. Prepare the inhaler: Remove the cap and shake the inhaler vigorously 10 to 15 times to ensure the medication is evenly mixed. If the inhaler is new or has not been used for over a week, prime it by spraying a few test puffs into the air away from your face.
2. Exhale fully: Stand or sit upright. Breathe out gently and completely to empty your lungs as much as possible.
3. Position the inhaler: Hold the inhaler upright, with your thumb on the base and your index finger on the top. Position the mouthpiece between your teeth with your tongue under it and close your lips to create a tight seal.
4. Inhale the dose: As you start to breathe in slowly and deeply through your mouth, press down on the top of the inhaler once. Continue to breathe in steadily.
5. Hold your breath: Remove the inhaler from your mouth and hold your breath for up to 10 seconds, or as long as is comfortable.
6. Exhale slowly: Breathe out slowly and gently.
7. Repeat puffs (if needed): If a second puff is prescribed, wait about one minute, shake the inhaler again, and repeat the steps.
8. Rinse your mouth: If your inhaler contains a corticosteroid, rinse your mouth and gargle with water, then spit it out to prevent oral thrush.

MDI Technique (with a spacer)

Using a spacer is often recommended, especially for children or those with difficulty coordinating breathing and actuation. It improves medication delivery to the lungs and reduces side effects.

1. Prepare the device: Shake the MDI well and attach it firmly to the spacer's back opening.
2. Exhale: Breathe out completely away from the spacer mouthpiece.
3. Position the spacer: Place the mouthpiece between your teeth and seal your lips tightly around it. For children, a mask may be used.
4. Release the dose: Press the inhaler once to release one puff of medicine into the spacer's chamber.
5. Inhale slowly: Breathe in slowly and deeply through your mouth. If the spacer whistles, you are breathing too fast. If a single deep breath is difficult, breathe in and out normally for 4–6 breaths.
6. Hold your breath: Hold your breath for about 10 seconds, then breathe out slowly.
7. Repeat puffs (if needed): Wait 30-60 seconds between puffs. Shake the inhaler again before releasing the next dose into the spacer.
8. Rinse your mouth: Rinse and spit if using a steroid inhaler.

Using a Dry Powder Inhaler (DPI)

Unlike MDIs, DPIs contain powdered medication and don't use a propellant. They require a quick, forceful inhalation to pull the medicine into your lungs.

1. Prepare the dose: Load a dose according to the device's specific instructions (e.g., twist the base, slide a lever, or insert a capsule). Do not shake a DPI.
2. Exhale fully: Breathe out completely away from the mouthpiece.
3. Inhale quickly and deeply: Place your lips firmly around the mouthpiece. Inhale rapidly and forcefully through your mouth until your lungs are full.
4. Hold your breath: Take the inhaler out of your mouth and hold your breath for up to 10 seconds.
5. Exhale slowly: Breathe out slowly away from the inhaler.
6. Rinse your mouth: If using a corticosteroid DPI, rinse your mouth with water and spit it out.

Common Mistakes to Avoid

Many patients make critical errors that compromise the medication's effectiveness.

• Poor Coordination: With MDIs, many people fail to synchronize pressing the canister with their inhalation. A spacer can resolve this issue.
• Incorrect Breathing Speed: Inhaling too fast with an MDI or too slowly with a DPI prevents the medication from reaching the lungs effectively.
• Not Exhaling First: Failing to breathe out completely before inhaling means there is less room for the medication-filled air.
• No Breath Hold: Holding your breath for 5-10 seconds allows the medication to settle in your airways. Skipping this step significantly reduces the dose delivered.
• Not Shaking MDI: MDI medication and propellant must be mixed by shaking before each puff. DPIs, however, should not be shaken.
• Forgetting to Rinse: Skipping the mouth rinse after using a steroid inhaler can lead to oral thrush, a fungal infection.

Inhaler Type Comparison: MDI vs. DPI

Feature	Metered-Dose Inhaler (MDI)	Dry Powder Inhaler (DPI)
Medication Form	Pressurized liquid or aerosol	Fine powdered medication
Inhalation Technique	Slow, steady, and deep breath	Quick and forceful breath
Coordination Required	Requires timing actuation with inhalation. Often improved with a spacer.	Breath-activated, so no timing is needed, making it easier for some users.
Propellant	Uses a chemical propellant to push the medicine out.	No propellant is used; inhalation power draws the dose.
Side Effects	Increased risk of oral thrush with steroids if no spacer is used or mouth is not rinsed.	May contain lactose, a potential allergen for some. Also requires rinsing with steroids.
Cleaning	Plastic casing and cap are washed with warm water and air-dried weekly.	Wiped clean with a dry cloth only.

Proper Cleaning and Storage

To ensure your inhaler functions optimally, regular cleaning is essential.

• MDI Cleaning: At least once a week, remove the metal canister and rinse the plastic mouthpiece and cap thoroughly under warm running water for 30 seconds. Allow all parts to air-dry completely overnight before reassembling. Never submerge the metal canister in water.
• DPI Cleaning: Most DPIs should never be washed with water, as moisture can cause the powder to clump. Instead, wipe the mouthpiece with a dry cloth or tissue. Follow your device's specific instructions for cleaning.
• Storage: Store all inhalers at room temperature away from extreme heat or cold. Always replace the cap after each use to keep debris out of the mouthpiece.

Conclusion

Maximizing the therapeutic benefits of inhaled medication depends heavily on mastering the correct technique for your specific device. By understanding the differences between MDIs, DPIs, and the role of a spacer, you can significantly improve medication delivery to your lungs and better manage your respiratory condition. Consistent practice and following the proper steps will lead to more effective treatment and a better quality of life. If you have any doubts about your technique, do not hesitate to ask a healthcare professional, such as a doctor or pharmacist, for a demonstration. Regular reviews can help maintain good habits over time.

For more information on respiratory health and devices, you can consult reliable sources such as the American Lung Association.

Frequently Asked Questions

How do I know if I am using my MDI inhaler correctly?

If you are using an MDI without a spacer and see a spray coming from your mouth or nose, or if you hear no sound while inhaling with a spacer (which means you're breathing slowly enough), your technique is likely correct. The best indicator is improved symptom control. If your symptoms are not improving, consult a healthcare provider.

What is the difference in breathing technique between an MDI and a DPI?

For an MDI, you need a slow, deep, and steady breath as you press the canister. For a DPI, you need a quick and forceful breath to activate the release of the dry powder.

Do I need to prime my inhaler?

Yes, metered-dose inhalers (MDIs) must be primed before their first use, if they haven't been used for several weeks, or if they have been dropped. Priming involves spraying a few test puffs into the air. Dry powder inhalers (DPIs) do not require priming.

Why is it important to rinse my mouth after using a steroid inhaler?

Rinsing your mouth and gargling with water after using a steroid inhaler and spitting it out is crucial to prevent the medication from causing a fungal infection called oral thrush.

How long should I wait between puffs?

For an MDI, you should wait at least 30 to 60 seconds between puffs to ensure the first dose has settled and the medication and propellant have time to remix. For most DPIs, no waiting is required between doses.

How can a spacer help me use my inhaler better?

A spacer holds the medication in a chamber after it is released, giving you more time to inhale it effectively. This improves the amount of medication reaching your lungs and can help people who have difficulty coordinating their breathing.

How often should I clean my inhaler?

The plastic components of an MDI should be cleaned at least once a week by rinsing them with warm water. Dry powder inhalers should be wiped clean with a dry cloth as per the manufacturer's instructions, as water can ruin the medication.