How to use your inhaler device

The aim of managing asthma is to put you in control of your condition rather than letting the asthma control you. Using your inhaler correctly can help you manage your asthma better because you’re getting the right amount of medicine into your lungs where it can work to reduce your asthma symptoms.

For example, if you’re using your preventer inhaler regularly and correctly, it can help you to stop being breathless exercising; to cope better with your triggers such as pollen, cold weather, dust, pollution or pets; to sleep better as you won’t be coughing at night; to have less time off work or school; and to take part in family activities. It also cuts your risk of an asthma attack.

Some people have told us that inhalers can be tricky to use, and even if you think your inhaler technique is correct, it might not be!

If you’re NOT using your inhaler correctly, you might not be getting the full dose of medicine your doctor or asthma nurse prescribed because the medicine can’t reach your lungs. Instead it might be hitting the back of your throat, or staying on your tongue or in your mouth where it won’t help at all.

Ask your GP, asthma nurse or pharmacist to show you how to use all your inhalers correctly when they’re first prescribed. After this, take your inhalers (and spacer) with to every single visit so that they can go through it again with you. It’s best if you actually show the doctor what you are doing so they can see whether you need to do things a bit differently.

There are lots of different types of inhalers and that they work in different ways. If it’s been a while since you were last shown, it’s easy for little mistakes to slip into your routine, or you may need to update your technique because the design of your inhaler may have changed.

Types of asthma inhalers and how to use them

There are different kinds of asthma inhalers, with different types of medicine in them. Because these inhalers are used in different ways you may find some easier to use than others. Your GP or asthma nurse can talk you through the different types of inhaler devices available and help you to decide which one is best for you.

The most common “asthma pump” is the ‘press and breathe’ metered dose inhalers (MDIs). MDIs work better with a spacer. Spacers collect the medicine inside them, so you don’t have to worry about pressing the inhaler and breathing in at exactly the same time. This makes these inhalers easier to use and more effective.

An MDI inhaler uses a small canister with a mixture of your medicine and a gas or liquid that turns the medicine into a very fine spray as you press on the canister. Most people call this a ‘puff’ of medicine. To get the best result you should shake the inhaler before each puff so that the medicine mixes well before use.

If you have a ‘press and breathe’ MDI inhaler and are using it directly in your mouth the steps to follow for the “single breath inhalation technique” are:

1. Shake
2. Insert into mouth with good seal
3. Breathe out as much as possible
4. Start breathing in slowly
5. Actuate inhaler immediately after inhalation
6. Breathe in slowly to full lung capacity
7. Hold breath for 10 seconds
8. Breathe out through nose

This is the same technique that you could use with a spacer, especially if you can take all the air from the spacer in with one long slow breath. Using a spacer helps you get more medication to the lungs and is recommended for all children and for adults with difficult to control asthma.

Children who cannot take one breath in or who cannot co-ordinate pressing the canister at the same time as breathing in, should use a spacer with a one way valve at the front, and use the “6 breath technique”.

1. Use with a valved spacer
2. Shake
3. Insert into mouth with good seal
4. Actuate inhaler
5. Breathe in and out slowly to full inhalation and full exhalation
6. Repeat 6 times

Very small babies who cannot put the spacer in their mouths properly will have to have a face-mask between them and the spacer. Use the “6 breath technique” but make sure there is a very good seal between the facemask and the face otherwise the air will come in through the side and no medicine will go into the lungs. Remove a face mask as soon as a child is able to breathe in and out through their mouths alone

‘Breathe in normally’ breath actuated MDIs are activated by your breath so that when you breathe in normally through the mouthpiece, it releases medicine in a fine spray form. With this inhaler you don’t have to push the canister to release a dose. You still need to shake these inhalers before each puff so that the medicine mixes well before use.

‘Breathe in hard’ dry powder inhaler (DPIs) have a fine powder in a capsule, rather than a spray in a canister. They release medicine in very fine powder form when you breathe in through the mouthpiece. You need to breathe in fairly hard to get the powder into your lungs.

You do not have to shake a dry powder inhaler.

• Prime the device (click the button or turn the top to open up the capsule of powder)
• Breathe in hard and as long as possible
• Hold your breath for 10 seconds
• Breathe out through nose

Nebulisers turn liquid medicine into a spray of mist. The reason many people think nebulisers work better than pumps is because there is so much more medicine in each nebuliser does than in a pump. Pumps are actually better than nebulisers at giving medicine to the lungs because the spray droplets are much smaller. When using a nebuliser breathe slowly and deeply through the mouth as far in and as far out as possible. Use a mouthpiece rather than a facemask.

• Not breathing out first. When you breathe out as much as you can just before taking your inhaler, you make more space in your lungs for your next breath in. This means that you can breathe in deeper and for longer when you breathe in your asthma medicine – giving it the best chance of reaching the small airways deep inside your lungs, and being most effective.
• Not holding your breath after taking your inhaler. If you’ve been advised to hold your breath after taking in your inhaler, it’s very important to do so. When you hold your breath after inhaling the medicine, you are keeping your airways still. This gives more time for the medicine to get into your lungs. If you can hold your breath for 10 seconds, this is ideal.
• Inhaling too early before pressing the canister. If you’re already half way through breathing in by the time the medicine is released from the inhaler, you won’t have enough time to finish breathing in all the medicine because your lungs will already be full. If this happens, some of the medicine will end up being sprayed in your mouth and hitting the back of your throat and not being carried down to your lungs where it’s needed.
• Inhaling too late after pressing the canister (unless you’re using a spacer). It takes less than half a second from the time the canister is pressed for all the medicine inside the inhaler to be released. If you breathe in after this time, some of the medicine will end up being sprayed in your mouth and not being carried down to your lungs where it’s needed.
• Not leaving enough time between doses. Never use two or more puffs of medicine straight after each other or at the same time into a spacer! There is only enough room in a spacer for one puff of medicine. You also need time to give your inhaler a good shake between doses and then wait 30 to 60 seconds before taking the next puff.
• Not breathing out first. When you breathe out as much as you can just before taking your inhaler, you make more space in your lungs for your next breath in. This means that you can breathe in deeper and for longer when you breathe in your asthma medicine – giving it the best chance of reaching the small airways deep inside your lungs, and being most effective.
• Not holding your breath after taking your inhaler. If you’ve been advised to hold your breath after taking in your inhaler, it’s very important to do so. When you hold your breath after inhaling the medicine, you are keeping your airways still. This gives more time for the medicine to get into your lungs. If you can hold your breath for 10 seconds, this is ideal.
• Inhaling too early before pressing the canister. If you’re already half way through breathing in by the time the medicine is released from the inhaler, you won’t have enough time to finish breathing in all the medicine because your lungs will already be full. If this happens, some of the medicine will end up being sprayed in your mouth and hitting the back of your throat and not being carried down to your lungs where it’s needed.
• Inhaling too late after pressing the canister (unless you’re using a spacer). It takes less than half a second from the time the canister is pressed for all the medicine inside the inhaler to be released. If you breathe in after this time, some of the medicine will end up being sprayed in your mouth and not being carried down to your lungs where it’s needed.
• Not leaving enough time between doses. Never use two or more puffs of medicine straight after each other or at the same time into a spacer! There is only enough room in a spacer for one puff of medicine. You also need time to give your inhaler a good shake between doses and then wait 30 to 60 seconds before taking the next puff.