If you have chronic obstructive pulmonary disease (COPD) or asthma and your doctor has prescribed an inhaler, you know that using it is essential to help control your lung disease. But clinical studies show that more than half of patients don’t use their inhalers correctly, and they’re not getting enoughmedication delivered to their lungs, thus compromising the drug’s effectiveness.
There are three main types of inhalers: a metered-dose inhaler (MDI), a dry-powder inhaler, and a soft mist inhaler. The most common way of inhaling medications is by using an MDI, a pressurized canister that releases an aerosol spray. Inhaler use can be difficult because it requires coordination between the release of the medication and your inhalation. It also requires some hand dexterity, which can be a challenge for people with arthritis, for example.
The key to getting the most from your MDI is to use the proper technique. Read the directions on the package insert for how to use your inhaler, which will include instructions on shaking and priming the inhaler (releasing a certain number of sprays in the air before you use the inhaler).
The following general steps will ensure that the proper amount of medicine reaches your lungs. If you’re still not sure you’re using the inhaler correctly, ask your doctor to watch as you use it to make certain you’re employing the proper technique.
Step 1. Place the metal canister into the plastic mouthpiece if it isn’t already inserted, and prime the inhaler if it’s new, hasn’t been used in a few days, or has been dropped.
Step 2. Remove the cap from the mouthpiece and shake the inhaler for 5 to 10 seconds.
Step 3. Hold the inhaler upright with your index finger on top of the canister and your thumb underneath the inhaler for support.
Step 4. If your doctor recommends the open-mouth technique (see first illustration), hold the mouthpiece one to two inches (about the width of two or three fingers) from your mouth, tilt your head back slightly, and open your mouth wide. Be careful when using the open-mouth technique to avoid directing the stream at your eyes or cheeks.
If your doctor recommends the closed-mouth technique (see second illustration), place the mouthpiece in your mouth with your lips sealed tightly around it while keeping your tongue underneath it. For both techniques, breathe in slowly as you press your index finger down once on the metal canister to release a puff of medication.
Step 5. Continue to inhale until your lungs are full (about 5 to 10 seconds). Inhaling too quickly will increase the amount of the medicine that sticks to the back of the throat.
Step 6. Hold your breath for 5 to 10 seconds or as long as you can do so comfortably.
Step 7. Before exhaling, move the inhaler from your mouth and release your finger from the canister if you haven’t already done so.
Step 8. For an additional dose, wait 15 to 30 seconds between sprays.
Step 9. If you’re using a steroid (glucocorticoid) inhaler, rinse your mouth with water, gargle, and spit the water out.
Step 10. Wipe off the mouthpiece and replace its cap to avoid contamination by dust and other particles.
Step 11. Clean the plastic mouthpiece once a week or as directed by the manufacturer by removing the metal canister and rinsing the plastic portion in warm water; allow it to air dry. Replace the metal canister andthe cap on the mouthpiece. Because inhalers can clog, clean them regularly. Check your inhaler’s package insert for more specific cleaning instructions.
Using a spacer or a chamber with your inhaler
Spacers and valve holding chambers are devices that hold the medication for a few seconds after it has been released from the inhaler. This delay can be helpful for people who have difficulty coordinating their breathing with the use of an inhaler. Both devices extend the mouthpiece of the inhaler and directthe medication to the back of the mouth.
Additionally, a holding chamber is designed with a one-way flap that traps and suspends the medication long enough for you to inhale over three to five seconds. It’s a good choice if you have a hard time triggering the MDI and breathing in at the same time. Spacers and holding chambers are simple to use, can be fitted to most inhalers, and can be rigid or collapsible.
If after repeated practice you’re still having trouble using your inhaler, ask your doctor if the medication is available in a differently designed device that’s easier for you to use. It may also be available in a formulation delivered through a nebulizer.
This article first appeared in the May 2019 issue of UC Berkeley Health After 50.
Also see 7 Tips to Help You Breathe More Easily.