How to Use Inhalers

Inhaled Medicines

Inhaling is often the best way to take medicine for asthma, COPD and other lung diseases. Inhaled medicines go directly to the airways and cause fewer side effects.  There are several types of inhalers.  Some common ones are the metered-dose inhaler (MDI), the Aerolizer inhaler, and the dry-powder inhalers (Diskus and Turbuhaler).  The metered-dose inhaler has been available for years.  The dry-powder inhaler and the Aerolizer are newer.

This page does not tell you about all the devices available to inhale medicine. New devices are coming on the market. It is very important to learn the correct way to use your inhaling device.  For devices not in page, be sure you get detailed instructions.  Read the package insert, which may have printed instructions with diagrams.  Also ask your health care team to watch how you use the inhaling device.

Metered-dose Inhalers

There are 3 different methods for using metered-dose inhalers (MDIs):

  • Closed-mouth method
  • Spacer method
  • Open-mouth method

The open-mouth technique used to be the preferred method before 2008 when the propellant in the MDIs changed.  The spacer method is often preferred for controller medicines.  A spacer deposits less medicine in your mouth and the back of your throat.  With a spacer, you can inhale more medicine directly into your lungs, where you need it.  The next preferred method is the closed-mouth method.  It’s important to become very familiar with the method you use.  This will ensure that you get the most benefit from your medicine.

Closed-Mouth Method

Follow these steps:
  1. Remove the cap. Hold the inhaler upright.
  2. Check to be sure the mouth piece is free of any foreign object (such as a coin).
  3. Shake the inhaler.
  4. Tilt your head back slightly. Breathe out slowly.
  5. Place the inhaler in your mouth. Close your mouth.
  6. Press down on the canister firmly as you start to breathe in slowly. (Press down until the medicine is released.)
  7. Breathe in slowly for a count of 3 to 5seconds.
  8. Hold your breath for a slow count to 10 (10 seconds).
  9. If more puffs are prescribed, the ideal is to wait between doses.
    • For bronchodilators that are short-acting beta agonists, it is best to wait 3 to 5 minutes. These fast-acting inhalers begin to open your airways quickly. When you wait after your first dose, the next doses can go deeper into your lungs. See “How to Sequence Inhalers” .
    • For other inhalers, try to wait 1 minute between puffs. 
  10. Rinse and gargle with water after using any steroid inhaler (even when it’s combined with another medicine).

Note: If you carry your inhaler in your purse or pocket, make sure the cap stays secured. If the cap comes off, be sure to check the mouth piece for foreign objects (such as a coin) before you use the inhaler.

Spacer Method

Spacer devices offer several benefits.  When you use a spacer, more medicine reaches your lungs, where you need it.  Less medicine is deposited on your tongue and the back of your mouth.  Side effects also are fewer and milder.  For example, you will have less hoarseness and fewer mouth and throat reactions.  If it’s hard for you to compress the canister and inhale at the same time, your medicine dose may be more effective when you use a spacer.

There are several types of spacers available.  It’s important that you follow the instructions on the package insert for your particular spacer.  Follow these steps:

  1. Remove the caps. Check to be sure the inhaler and spacer are free of any foreign object (such as a coin).
  2. Attach the inhaler to the spacer.
  3. Shake well.
  4. Tilt your head back slightly. Sit upright, and breathe out normally.
  5. Place the mouth piece into your mouth. Close your lips around it.
  6. Press down on the canister firmly until the medicine is released. This will put 1 puff of the medicine into the spacer.
  7. Breathe in slowly for a count of 3 to 5seconds. Many spacers whistle if you inhale too fast.
  8. Hold your breath for a slow count to 10 (10 seconds).
  9. Remove the spacer from your mouth, and then breathe out slowly.
  10. If more puffs are prescribed, the ideal is to wait between doses. This will make the medicine more effective.
    • For bronchodilators that are short-acting beta agonists, it is best to 3 to 5 minutes. These fast-acting inhalers begin to open your airways quickly. When you wait after your first dose, the next doses can go deeper into your lungs. See “How to Sequence Inhalers".
    • For other inhalers, try to wait 1 minute between puffs. 
  11.  Rinse and gargle with water after using any steroid inhaler (even when it’s combined with another medicine).

Note: If you carry your inhaler and spacer in your purse or pocket, make sure the caps stay secured.  If the cap comes off, be sure that the inhaler and spacer are free of foreign objects (such as a coin) before use.

Open-Mouth Method

Follow these steps:
  1. Remove the cap. Hold the inhaler upright.
  2. Check to be sure the mouth piece is free of any foreign object (such as a coin).
  3. Shake the inhaler.
  4. Tilt your head back slightly. Breathe out slowly.
  5. Place the inhaler 1 to 2 inches in front of your open mouth (the width of 2 fingers).
  6. Press down on the canister firmly as you start to breathe in slowly. (Press down until the medicine is released.)
  7. Breathe in slowly for a count of 3 to 5 seconds.
  8.  Hold your breath for a slow count to 10 (10 seconds). 
  9. If more puffs are prescribed, the ideal is to wait between doses. This will make the medicine more effective.
    • For bronchodilators that are short-acting beta agonists, it is best to wait 10 minutes between doses. But you may find it more practical to wait 3 to 5 minutes. These fast-acting inhalers begin to open your airways quickly. When you wait after your first dose, the next doses can go deeper into your lungs. See “How to Sequence Inhalers”.
    • For other inhalers, try to wait 1 minute between puffs.
  10.  Rinse and gargle with water after using any steroid inhaler (even when it’s combined with another medicine).

Note: If you carry your inhaler in a purse or pocket, make sure the cap stays secured.  If the cap comes off, be sure to check the mouth piece for foreign objects (such as a coin) before you use the inhaler.

Doses Left

You can use the math method below to find out how much medicine is left in your MDI.

Number of days. To find out the number of days that you can use a new MDI, follow the steps below.

Step 1: Each inhaler is marked with the number of doses it contains. Find the number of doses marked on your inhaler. Example: 200 doses (or puffs)

Step 2: Add up the number of puffs you use each day. Example: 2 puffs in the morning plus 2 puffs in the evening = 4 puffs per day

Step 3: Take the number of doses (puffs) marked on your new inhaler. Divide it by the number of puffs you use each day. Example: 200 doses (puffs) divided by 4 puffs = 50 days of use

Take the number of days of use in your new inhaler. On your calendar, count that number of days ahead from the first day you will use the inhaler. Mark the date on your calendar that shows when the inhaler will be empty. Refill your inhaler prescription a day or two before the target empty date. Also, write the target empty date on the canister with an indelible marker.

Number of doses. To find out the number of doses left in your MDI, follow the steps below.

Step 1: Count the number of puffs you have used from one inhaler for a certain number of days. Example: 4 puffs per day times 40 days =160 puffs used

Step 2: Subtract the number of puffs used from the total doses (puffs) marked on the inhaler. Example: 200 doses (puffs) minus 160 puffs used = 40 puffs left

Step 3: Divide the number of puffs left by the number of puffs you will use each day. Example: 40 puffs left divided by 4 puffs per day = 10 days of use left

The math method works only if you take a set number of puffs every day from your inhaler. If you use your inhaler “as needed,” this method does not work.

Note: There is a device on the market that attaches to your canister and counts the number of doses used. There is also a sticker that attaches to your canister that allows you to scratch off each dose as you use it.

MDI Care 

Metered-dose inhalers. New MDIs are to be primed into the air when first opened so that the medicine loads into the canister. MDIs that have counters are not to be taken apart to be cleaned.  Read the specific instructions on how to clean them.  If your MDI does not have a counter, rinse the mouth piece (plastic housing) and cap weekly in warm running water. Wash the mouth piece and cap in mild soap and rinse in warm water at least 2 times a week, and more often if you have an infection. The mouth piece and cap must be dry before you use the inhaler again.  While the cleaned inhaler is drying, you must use another inhaler.
 
Spacers. Clean your spacer well. Follow the instructions on the package insert for your specific spacer.

 

Dry-powder Inhaler

The Diskus is a dry-powder inhaler.

How to Use the Diskus Inhaler

Follow these steps:
  1. Hold the Diskus with one hand.
  2. Place your thumb on the thumb grip. Then push it as far away from you as it will go. You will now see the mouth piece.
  3. Slide the “trigger” away from you until you hear it click. Your dose is now ready to be inhaled.
  4. Bring the Diskus opening up to your mouth. Be careful not to tilt the Diskus.It must stay in a level position until after you inhale the medicine.
  5. Place the Diskus opening up to your mouth. Take in a slow, deep breath. As you breathe in, count to 5. This allows you to breathe all the medicine into your airways.
  6. Hold your breath for up to 10 seconds. Move the Diskus away from your mouth.
  7. Breathe out slowly.
  8. Close the Diskus by sliding the thumb grip back over the mouth piece.
  9. Rinse and gargle with water. This helps prevent hoarseness and an infection in your mouth from the inhaled steroids.

Doses Left

A counter on top of the Diskus shows how many doses are left. Each time you click the trigger, 1 dose is released, and the counter reduces by 1.

Diskus Care

Do not wash Diskus inhalers after use.  You may wipe them with a clean, damp cloth to remove any residue.  The Diskus must always be kept dry.

 

How to Sequence Inhalers

Many people use several inhalers at a time. You may wonder which inhaler you should use first.  Keep in mind that bronchodilators work faster than inhaled steroids.  Use bronchodilators first because these fast-acting inhalers open your airways quickly.  Use the inhaled steroids last, so then they can go deeper into your lungs.

The general rules are:

  • First, use your fastest-acting bronchodilator, for example, albuterol.
  • Next, use any other bronchodilators prescribed for your regular use, for example, Atrovent or Serevent.
  • Last, use your steroid inhaler.

When should you seek help?

If any of the following happen to you, take steps to get medical care:

  • Your mucus changes in color, consistency, or amount.
  • Your wheeze, cough, or shortness of breath gets worse, even after you take your medicine and it has time to work.
  • Your breathing gets more difficult or your fingers turn blue.
  • You have trouble walking, talking or thinking.

Call 911 right away if you are struggling to breathe.

If you have questions

If you have any questions, call your doctor or nurse at _________________________.

 

Reviewed 2011

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