Taking your asthma medicine regularly is an important part of controlling your asthma. But do you know how you take your medicine is just as important?

Why Is Correct Asthma Inhaler Use Important?

Incorrect inhaler use can stop your asthma medicines from getting to your lungs.

Inhaler mistakes are more common than you might think. Up to 92% of people with asthma use their devices incorrectly.¹

If your medicine isn’t reaching your lungs, your asthma might be harder to control.

Using your inhaler incorrectly may lead to:^2,3

• More asthma episodes
• More emergency room visits
  
  

Small changes in how you take your asthma medicines may help you breathe better and have better quality of life.

Even if you’ve been using an inhaler for many years, it’s always a good idea to review how you use your inhaler from time to time. This can help you avoid small mistakes. This is especially important when you start taking a new type or brand of inhaler.

What Types of Asthma Devices Are Available?

In order to learn how to take your medicine the right way, it helps to learn about the different types of asthma devices.

Most asthma medicines are inhaled so they can get directly to the lungs. The medicines are put into a device that helps you breathe it in. This may be a handheld inhaler or a machine. These are the types of inhalers that deliver asthma medicine:

• Metered dose inhaler (MDI) – An MDI has a canister that contains the medicine and a propellant to help make the medicine airborne (or aerosol). The canister inserts into a plastic holder with a mouthpiece. You press the canister down to release a puff of medicine into the mouthpiece. You have to time your breath to breathe in the medicine as you press the canister down. These inhalers are sometimes called press-and-breathe inhalers. Before using one, you need to shake this type inhaler. This type of inhaler needs to be primed before using it for the first time or if it hasn’t been used in two weeks. Priming means you spray the medicine into the air away from your face so you can test the spray. MDIs (or press-and-breathe inhalers) deliver the medicine best when used with a spacer or valved holding chamber. A spacer or chamber holds the medicine in the chamber to give you a little bit more time to breathe it in.
  
  
• Breath actuated inhaler – This type of inhaler is not a press-and-breathe inhaler. When you take a fast, deep breath in, it pulls the medicine out of the device and into your lungs.
  
  
• Dry powder inhaler (DPI) – A DPI delivers medicine as a dry powder. It is a type of breath actuated inhaler. It delivers the medicine when you inhale.
  
  
• Soft mist inhaler – A soft mist inhaler delivers medicine in a mist form. You have to prepare a new soft mist inhaler by inserting a cartridge and priming it before you use it.
  
  

How Do You Prime an Asthma Inhaler?

When you open the package of a new inhaler, you may have to prime it. This will depend on the type of inhaler you have. MDIs and soft mist inhalers need to be primed before first use. Check your medicine’s instructions for more information about your device.

Breath actuated inhalers (like a RediHaler™) and DPIs (like an ADVAIR DISKUS) do not need to be primed.

Priming inhalers (MDIs and SMIs) is important because it:

• Mixes the propellant and medicine
• Tests the inhaler for clogs
• Tests that the medicine is inserted into the device correctly
  
  

If an inhaler needs to be primed before first use, the counter will include the extra puffs needed for first priming.

For example, an inhaler with 200 doses will have a counter that says 204. This means the inhaler can be primed four times before the first use as recommended.

Priming an MDI

Most MDIs need to be primed when you first open them. They also need to be primed if you haven’t used the inhaler for two weeks or more.

Priming the inhaler mixes the propellant and medicine. It is important to prime your inhaler to make sure you get the right amount of medicine in your lungs with each puff.

To prime your inhaler:

1. Remove the cap and shake it well for at least 5 seconds (about 10 hard shakes).
2. Spray it into the air and away from your face and other people.
3. Repeat as many times as needed according to the directions on the medicine.

Priming a Soft Mist Inhaler

Soft mist inhalers need to be primed only before the first use and they do not need to be shaken.

The soft mist inhaler comes in two pieces: the cartridge that holds the medicine and the inhaler that delivers the medicine. You must put the cartridge into the inhaler before you can use it.

1. With the cap closed, press the gray safety catch and pull the clear base of the inhaler.
2. Take the narrow end of the cartridge and push it into the inhaler as far as it will go.
3. Push the cartridge down firmly on a hard surface to make sure the cartridge has gone in all the way. (You will still see a small amount of the cartridge even after you push it in all the way.)
4. Put the clear base back into place.
   
   

Do not remove the cartridge or clear base once you have put the inhaler together.

To prime your soft mist inhaler:

1. Hold the inhaler upright with the cap closed.
2. Turn the clear base in the direction of the arrows until you hear a click.
3. Flip the cap open.
4. Point the inhaler down away from your face. Press the release button.
5. Close the cap.
6. Repeat steps 1 through 5 three more times.
   
   

How Do You Use Your Asthma Inhaler?

Once your inhaler is primed, it’s time to check your position. Your posture and position are an important part of making sure your asthma medicines get to your lungs.

Remember these steps to make sure you are in the best position possible when taking your asthma medicine:

• Stand or sit upright, if possible. This is the best position to open up your lungs.
• Face forward with your head upright, not tilted.
• Make sure the inhaler is upright and not tilted. Point the mouthpiece toward the back of your throat.
• If you have a DPI, don’t point it down during or after loading a dose.
• Seal your lips and teeth around the mouthpiece of the inhaler or spacer/chamber with your tongue down.
• Don’t block air vents. Use fingers, not a fist, to hold the inhaler.
  
  

How you inhale when using your asthma devices is important too. Remember these steps as you inhale the medicine:

• Blow air out of your lungs before each dose. This will help you take a deeper breath in when you inhale your medicine.
• Pace yourself as you inhale the asthma medicine. Try not to breathe in too fast or two slow for your device.
• If you have a breath actuated inhaler, make sure you are breathing in with enough force to pull the medicine out of the inhaler.
• Breathe in through your mouth, not your nose.
• Hold your breath for 10 seconds (or as long as you can) once the medicine is in your airways.
• If you cough in the middle of taking your inhaler, you may need to redo your puff.
• Wait 1 minute between doses to help the medicine settle in your lungs. Remember to shake your press-and-breathe MDI inhaler in between doses (not all inhalers need shaking!).
  
  

This video shows you how to use an MDI and ways you can improve your overall inhaler technique so you can make sure your asthma medicine is getting to your lungs where it needs to be.

Watch on YouTube

If you aren’t sure what kind of device you have or how to use it, ask your doctor or nurse to show you how to use it. Also, ask for instructions if you get a new type or brand of inhaler.

It’s also a good idea to review how you use your inhaler with your health care team during regular check-ups. They can help you spot ways to improve so you get as much medicine in your lungs as possible.

What Are Some Common Mistakes People Make When Using an Inhaler?

If you don’t use your inhaler correctly, you may not get the right amount of medicine. That can affect your asthma control.

When you use your inhaler, watch out for these common mistakes:

• Not inserting the canister properly into the device
• Forgetting to prime an inhaler that needs to be primed
• Not shaking the MDI (press-and-breathe) enough to mix the medicine and propellant or forgetting to shake this type of inhaler between each puff
• Forgetting to remove the inhaler cap
• Forgetting to breathe out fully before you take your puff
• Not holding yourself or the inhaler upright
• Not using a spacer/chamber with an MDI
• Not waiting long enough between puffs
  
  

The Asthma and Allergy Foundation of American (AAFA) has resources on how to use MDIs, DPIs, breath actuated inhalers, soft mist inhalers, and nebulizers. Download our FREE handout “How to Correctly Use Your Asthma Devices.”

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Medical Review: May 2022 by John M. James, MD

References
1. Bonds, R., Asawa, A. and Ghazi, A. (2015). Misuse of Medical Devices: a Persistent Problem in Self-Management of Asthma and Allergic Disease. Annals of Allergy, Asthma & Immunology, 114(1), pp.74-76.e2.
2. Melani, A. S., Bonavia, M., Cilenti, V., Cinti, C., Lodi, M., Martucci, P., Serra, M., Scichilone, N., Sestini, P., Aliani, M., & Neri, M. (2011). Inhaler Mishandling Remains Common in Real Life and Is Associated With Reduced Disease Control. In Respiratory Medicine (Vol. 105, Issue 6, pp. 930–938). Elsevier BV. https://www.resmedjournal.com/...(11)00009-6/fulltext
3. Vanoverschelde, A., Van Der Wel, P., & Lahousse, L. (2019). Poor Inhalation Technique Is a Major Determinant of Acute Exacerbations. In Airway Pharmacology And Treatment. ERS International Congress 2019 abstracts. European Respiratory Society. https://doi.org/10.1183/13993003.congress-2019.pa4236