How to Use an Inhaler Correctly: A Practical Guide

Inhaled medications are central to the management of many respiratory conditions. Delivering medication directly to the airways aims to optimize efficacy and minimize systemic effects. However, studies indicate that a significant proportion of patients may not use their inhalers with optimal technique ^[2].

Suboptimal inhaler technique can result in reduced medication delivery to the lungs, potentially leading to poorer symptom control.

This guide outlines general principles for the two broad categories of devices: Metered Dose Inhalers (MDIs) and Dry Powder Inhalers (DPIs).

Metered Dose Inhalers (MDIs)

An MDI is a pressurized device that releases a measured aerosol dose of medication.

Common Technical Challenges with MDIs

• Not shaking the inhaler before use (for suspensions).
• Difficulty coordinating the actuation of the canister with inhalation.
• Inhaling too rapidly.
• Not holding the breath sufficiently after inhalation.

General Technique Principles for MDIs

1. Preparation: Remove the cap and shake the inhaler (if recommended for your specific medication).
2. Exhalation: Breathe out gently away from the inhaler.
3. Positioning: Place the mouthpiece between the teeth and form a seal with the lips.
4. Inhalation: Begin breathing in slowly and deeply through the mouth. Simultaneously, press down on the canister once to release the dose.
5. Continue Inhaling: Continue the slow, deep breath until the lungs feel full.
6. Breath Hold: Remove the inhaler. Hold the breath for several seconds (often recommended up to 5-10 seconds, or as long as is comfortable) to allow the medication to settle in the airways.
7. Exhale: Breathe out gently.

[!TIP] Spacers/Valved Holding Chambers: For patients using MDIs, guidelines often suggest using a spacer device. A spacer can help overcome coordination difficulties and may increase the proportion of medication that reaches the lower airways while reducing deposition in the throat.

Dry Powder Inhalers (DPIs)

DPIs deliver medication as a fine powder. They are breath-actuated, meaning the patient's inspiratory effort draws the powder out of the device and into the lungs.

Common Technical Challenges with DPIs

• Incorrectly loading or priming the dose.
• Exhaling into the device, which can introduce moisture and affect the powder.
• Not inhaling with enough force to disperse the powder.

General Technique Principles for DPIs

1. Preparation: Prepare the dose according to the specific device's instructions. DPIs generally should not be shaken.
2. Exhalation: Breathe out gently and completely, away from the inhaler.
3. Positioning: Place the mouthpiece between the teeth and seal the lips around it.
4. Inhalation: Breathe in quickly, deeply, and forcefully. This strong inspiratory flow is needed to de-aggregate the powder and carry it to the lungs.
5. Breath Hold: Remove the inhaler. Hold the breath for several seconds (up to 5-10 seconds, or as comfortable).
6. Exhale: Breathe out gently away from the inhaler.

After Using Corticosteroid Inhalers

If an inhaler contains an inhaled corticosteroid (ICS), it is generally advised to rinse the mouth with water and spit it out after use. This practice helps reduce the risk of localized side effects, such as oral thrush or hoarseness.

Seeking Guidance

Inhaler technique should ideally be reviewed periodically by a healthcare professional. If respiratory symptoms remain uncontrolled, verifying proper inhaler technique is often an important step in clinical evaluation.