A recent study found that only 10% of people are able to demonstrate the correct asthma inhaler technique, although on average 75% of patients say they can use it the correct way. In tests the amount of medication entering the lungs was shown to vary from 33% in the best case to 0% at worst. Other research found that 91% of doctors and other healthcare professionals who teach patients inhaler use, "could not demonstrate all the recognised steps" in taking inhaled medication.
Using a metered-dose inhaler seems simple, but when used incorrectly less medicine gets to your lungs and most of it remains in the back of your mouth. By perfecting your technique you will be better able to control low-level symptoms and less likely to suffer a more serious asthma attack. Also the drugs are expensive so it's not a good idea to waste them.
If you have a spacer, you should use it. It helps get more medicine into your airways.
The instructions below are not for dry powder inhalers, which have different instructions. The Accuhaler, Easyhaler, Clickhaler, Novolizer, Diskhaler, Twisthaler and Turbohaler are all types of breath-activated dry powder inhalers. With these you need to breathe in fairly hard to get the powder into your lungs.
What are the types of asthma inhalers?
A metered-dose inhaler (MDI) is the most commonly used delivery system for treating asthma, chronic obstructive pulmonary disease (COPD) and other respiratory diseases.
The medication in a metered dose inhaler is most commonly a bronchodilator (the reliever or blue inhaler, often the Ventolin inhaler), corticosteroid (the preventer or brown inhaler, often the Clenil inhaler) or a combination of both for the treatment of asthma. Other medications less commonly used but also administered by MDI are mast cell stabilizers, such as cromoglicate or nedocromil.
The blue inhaler is taken to relieve asthma symptoms quickly. Examples of reliever medicines include salbutamol and terbutaline. They are generally safe medicines with few side effects, unless overused.
The preventer inhalers - usually orange, red or brown inhalers - work over time to reduce the amount of inflammation and sensitivity of the airways, therefore minimising the chances of an asthma attack. This type of inhaler contains corticosteroid, either beclometasone dipropionate (available as Clenil Modulite), budesonide, fluticasone, ciclesonide or mometasone.
Preventer treatment should be taken regularly if you have anything more than occasional symptoms from your asthma, and certainly if you feel the need to use a reliever inhaler more than twice a week.
How to get ready?
Take off the cap and shake the inhaler hard. If you have not used the inhaler in a while, you may need to prime it. See the instructions that came with your inhaler for how to do this.
How to breathe?
As well as failing to shake the inhaler before using it, common errors with inhaler use include inhaling too sharply or at the wrong time, or not holding your breath long enough after breathing in the contents.
Before taking a puff, breathe out all the way. Hold the inhaler one to two inches in front of your mouth (about the width of two fingers) and then breathe in slowly.
Start breathing in slowly through your mouth, then press down on the inhaler once. Keep breathing in slowly, as deeply as you can then hold your breath
If you can, hold your breath as you slowly count to ten. This lets the medicine reach deep into your lungs.
If you are using quick-relief medicine (the beta-agonists or blue inhaler), wait about one minute before you take your next puff. You do not need to wait a minute between puffs for other medicines.
After using your inhaler, rinse your mouth with water, gargle, and spit. This helps reduce the possible side effects.
How to maintain and store your inhaler?
It's important to keep the metered-dose inhaler clean, whether it is for yourself or for a child. Make sure the cap is on the MDI when it's not in use.
Make sure the hole where the medicine comes out is not plugged. Use a dry cloth or tissue to wipe off any powder around the hole or in it.
To wash it you will need to remove the metal canister from the L-shaped plastic mouthpiece. Rinse only the mouthpiece and cap in warm water then let them air dry overnight. In the morning, put the canister back inside and put the cap on. Do not rinse any other parts.
Store the inhaler at room temperature. Try not to not let it get cold or hot. If it gets cold, warm it with your hands only.
Check the expiry date of the MDI before you use it and it's a good idea to write on the metal canister the date it was first used. If you think there might be a problem with your spacer, or if you have been using it for one year, get someone to check it. A doctor, nurse, pharmacist, or respiratory therapist who teaches you about asthma can tell you if the spacer is working properly.
When to replace your inhaler?
Your inhaler will be empty when it feels very light and there is almost no sound from the canister when you shake it.
Especially with children, it's a good idea to count of the number of puffs your child takes regularly and compare this number to the total number of doses on the label. Write on the label the estimated date you will need to replace it. For example, say the new canister has 200 puffs listed on the label and the doctor advises you to take eight puffs a day, this canister would last 25 days.
Some MDIs have dose counters that let you know how many doses are left in the canister. A puff counter - a gadget that fits on top of the inhaler where you press - can also be bought at a pharmacy or online.
Do not put your canister in water to check if it is empty. This does not work.
How to use spacers?
An asthma spacer is an add-on device, a tube or chamber that fits in between the canister and the patient's mouth. They are designed to make aerosol inhalers easier to use, especially for children, since they hold the medication and allow you to breathe in slowly and deeply for five to ten breaths. You don't have to worry about pressing the inhaler and breathing in at exactly the same time.
They come in various types, either large or small volume in plastic or metal with a mouthpiece at one end and a hole to insert the inhaler at the other. Children under the age of three may have a spacer attached to a face mask rather than a mouthpiece.
When using a spacer, the vapour from the inhaler is released into the container, where it is held while you breathe in slowly and progressively until your lungs are full. You should then hold in your breath before relaxing so the vapour has time to settle in your lungs.
Spacers are also good for minimising any possible side effects, since more of the drug reaches your lungs rather than staying in your mouth or being swallowed. Many people prefer them, especially for the brown inhaler or preventer in regular use. Spacers are available on NHS prescription.
The Asthma UK website has helpful videos on how to use different types of spacers, how to help children with asthma and demonstrations of the correct breathing technique.
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