Breathe Easy: A Comprehensive Guide to Using Your Inhaler Correctly

Inhalers are a cornerstone of treatment for many respiratory conditions, such as asthma and chronic obstructive pulmonary disease (COPD). These devices deliver medication directly to your lungs, providing quick relief and managing symptoms effectively. However, an inhaler is only as effective as your ability to use it correctly. Improper technique can significantly reduce the amount of medication reaching your lungs, leading to poorly controlled symptoms and potentially more severe health issues. This comprehensive guide will walk you through the correct way to use different types of inhalers, provide troubleshooting tips, and highlight the importance of regular maintenance.

Why Correct Inhaler Technique Matters

Before diving into the specifics, let’s emphasize why proper inhaler technique is so crucial. When you use an inhaler incorrectly, the following can occur:

• Reduced Medication Delivery: The majority of the medication can end up in your mouth, throat, or even the air around you, instead of reaching your lungs where it’s needed. This means you’re not getting the full benefit of the medication.
• Poor Symptom Control: Insufficient medication in your lungs can lead to increased coughing, wheezing, shortness of breath, and other symptoms, impacting your quality of life.
• Increased Exacerbations: Poorly managed respiratory conditions can lead to more frequent flare-ups, which can be severe and require emergency medical care.
• Waste of Medication: Incorrect use wastes medication, costing you money and resources.

Understanding these consequences should highlight the importance of mastering the correct inhaler technique.

Types of Inhalers

There are several types of inhalers, each with its own specific instructions for use. The most common types include:

1. Metered-Dose Inhalers (MDIs): These are the most widely used type, often featuring a pressurized canister that releases a specific dose of medication as a fine mist.
2. Dry Powder Inhalers (DPIs): These inhalers deliver medication in a dry powder form, which is inhaled by the patient. They don’t use a propellant.
3. Soft Mist Inhalers (SMIs): These inhalers deliver a slow-moving mist of medication, which can be beneficial for individuals who have difficulty using other types of inhalers.

While the basic principles are similar, the precise steps for using each type can vary. Therefore, it’s crucial to know which type of inhaler you have and follow the specific instructions provided by your doctor or pharmacist.

Using a Metered-Dose Inhaler (MDI)

Let’s break down the steps for using an MDI correctly, which is perhaps the most common type of inhaler. Remember, practice makes perfect, so don’t be discouraged if you don’t get it right the first time.

Step-by-Step Guide to Using an MDI:

1. Prepare the Inhaler:
   • Remove the cap: Take the cap off the mouthpiece of the inhaler.
   • Shake Well: Shake the inhaler vigorously for 5-10 seconds. This mixes the medication with the propellant and ensures you get a consistent dose.
   • Prime if Needed: If it is a new inhaler or if it hasn’t been used for a couple of weeks, or as directed in the package insert, prime the inhaler by spraying one or two puffs into the air away from your face and eyes.
2. Position Yourself:
   • Sit or Stand Upright: Sit or stand upright. This position allows for better lung expansion and medication delivery.
   • Exhale Fully: Breathe out all the air from your lungs. This will make room for a deep inhalation of the medication.
3. Proper Inhaler Placement:
   • Option 1: Inhaler Directly to Mouth: Place the inhaler mouthpiece between your teeth, but don’t bite down. Close your lips around the mouthpiece to create a tight seal.
   • Option 2: Using a Spacer: Attach the spacer to the mouthpiece of the inhaler. Then place the mouthpiece of the spacer between your teeth, and seal your lips around it. This is strongly recommended, especially for children, seniors, or anyone who has difficulty coordinating pressing the inhaler and breathing in.
4. Inhale and Activate the Inhaler:
   • Start to inhale: As you begin to take a slow, deep breath, press the top of the inhaler canister firmly to release one puff of medication.
   • Continue Breathing In: Keep breathing in slowly and steadily, deeply through the mouth, for about 3-5 seconds. Do not stop breathing while pressing and inhaling.
5. Hold Your Breath:
   • Hold: After inhaling the medication, hold your breath for about 10 seconds, or as long as you comfortably can. This allows the medication to deposit in your lungs.
6. Exhale Slowly:
   • Exhale: Slowly breathe out through your nose or mouth, away from the inhaler.
7. Repeat as Needed:
   • Second Dose: If your doctor has prescribed more than one puff, wait 15-30 seconds, then repeat the steps starting from “Shake Well.” Always check your specific medication instructions.
8. Rinse Your Mouth:
   • Rinse: After you have taken all of your required puffs, rinse your mouth with water and spit it out. This helps to prevent thrush (a fungal infection in the mouth) and throat irritation, especially when using inhaled corticosteroids. Do not swallow the water.
9. Replace Cap:
   • Cover the mouthpiece: Put the cap back on the inhaler to protect it from dust and debris.

Key Considerations for MDIs

• Coordination: The most common mistake with MDIs is poor coordination between pressing the inhaler and inhaling. Using a spacer can greatly improve this coordination.
• Spacer Usage: Spacers are highly recommended for children and older adults. Spacers allow the medication to be held in suspension after activation, allowing patients to inhale the medication without needing to synchronize the two actions.
• Breathing Technique: Focus on slow, deep breaths, not short, quick breaths.
• Proper Storage: Store your inhaler at room temperature and away from excessive heat or cold.
• Cleaning: Clean your inhaler’s mouthpiece regularly, following the manufacturer’s instructions. The spacer should also be cleaned according to the instructions.

Using a Dry Powder Inhaler (DPI)

Dry powder inhalers (DPIs) deliver medication in a powdered form. Unlike MDIs, DPIs don’t require a propellant, and your breathing creates the force to draw the powder from the inhaler into your lungs. While specific designs vary, the general steps are as follows:

Step-by-Step Guide to Using a DPI

1. Prepare the Inhaler:
   • Open the Inhaler: Depending on your DPI, you might need to open the device by twisting, sliding, or clicking a lever. Refer to the manufacturer’s instructions.
   • Load the Dose: For some DPIs, you need to load the dose by turning a lever or pressing a button. This will vary by brand. Follow the instructions to ensure that a dose is ready.
2. Position Yourself:
   • Sit or Stand Upright: As with MDIs, sit or stand up straight.
   • Exhale Fully: Breathe out completely before inhaling.
3. Proper Inhaler Placement:
   • Place Mouthpiece: Place the mouthpiece between your teeth and close your lips tightly around it. Make sure that you do not block the air vents on the sides of some DPIs.
4. Inhale and Activate the Inhaler:
   • Inhale Forcefully: Take a quick, deep and strong breath in through the inhaler. You don’t need to press anything while inhaling, unlike an MDI. The force of your breath will release the powder into your lungs.
5. Hold Your Breath:
   • Hold: Hold your breath for about 10 seconds or as long as comfortable.
6. Exhale Slowly:
   • Exhale: Slowly breathe out away from the inhaler.
7. Repeat as Needed:
   • Second Dose: If prescribed more than one dose, reload the next dose following the manufacturer’s instructions and repeat all steps.
8. Rinse Your Mouth:
   • Rinse: After you have taken all of your required puffs, rinse your mouth with water and spit it out. This helps to prevent thrush (a fungal infection in the mouth) and throat irritation, especially when using inhaled corticosteroids. Do not swallow the water.
9. Close the Inhaler:
   • Close: Close the inhaler as directed to protect it from moisture.

Key Considerations for DPIs

• Breath Strength: DPIs require a strong, forceful inhalation. If you have difficulty generating sufficient force, your doctor may suggest an alternative inhaler.
• Do Not Exhale Into Inhaler: Be very careful not to breathe or exhale into the DPI mouthpiece as this will cause the medication to be wasted and can clog the device.
• Keep Dry: Always store the inhaler in a dry place and do not wash or get it wet.
• Avoid Spacers: Spacers are not used with DPIs.

Using a Soft Mist Inhaler (SMI)

Soft Mist Inhalers (SMIs) deliver medication as a fine, slow-moving mist that can be easier for some people to inhale. Like DPIs, they don’t use a propellant but they also require specific steps.

Step-by-Step Guide to Using an SMI

1. Prepare the Inhaler:
   • Load Cartridge: Some SMIs come with cartridges that need to be inserted. Follow manufacturer’s instruction on how to load the cartridge.
   • Turn the Base: Turn the clear base until it clicks.
   • Open the Cap: Open the cap.
2. Position Yourself:
   • Sit or Stand Upright: As with other inhalers, sit or stand up straight.
   • Exhale: Exhale fully.
3. Proper Inhaler Placement:
   • Place Mouthpiece: Place the mouthpiece between your teeth and close your lips around it.
4. Inhale and Activate the Inhaler:
   • Press the Button: While breathing in slowly, press the dose-release button on the SMI.
   • Continue Inhaling: Continue to inhale slowly and deeply through the mouth for approximately 5-7 seconds.
5. Hold Your Breath:
   • Hold: Hold your breath for approximately 10 seconds, or as comfortable.
6. Exhale Slowly:
   • Exhale: Slowly breathe out through your nose or mouth.
7. Repeat as Needed:
   • Second Dose: If you need a second dose, repeat all steps.
8. Rinse Your Mouth:
   • Rinse: After you have taken all of your required puffs, rinse your mouth with water and spit it out. This helps to prevent thrush (a fungal infection in the mouth) and throat irritation, especially when using inhaled corticosteroids. Do not swallow the water.
9. Replace Cap:
   • Close the cap: Close the cap on the inhaler.

Key Considerations for SMIs

• Slow Inhalation: SMIs are designed for slow and steady inhalation, as opposed to the quick, forceful inhalation required for DPIs.
• Priming: SMIs will need priming when first used or when they haven’t been used in a couple of days. Follow the manufacturer instructions.
• Proper Technique: SMIs require careful attention to the order of steps and timing. Review and practice until you have the procedure down properly.
• Cleaning: Clean your SMI according to the manufacturer’s directions.

Troubleshooting Common Issues

Even with practice, you may encounter problems with your inhaler. Here are some common issues and how to address them:

• Difficulty coordinating MDI use: Use a spacer to help coordinate breathing and puff release.
• Not feeling the medication: Check expiration date and use correct technique to ensure the medication is reaching your lungs. If not resolved, see your doctor.
• Inhaler seems empty: MDIs may run out before a full count as the spray does not always have the full amount of medication. Keep track of your doses and have a refill ready.
• Coughing After Use: You might experience some coughing after using your inhaler, especially if it contains a steroid. This should ease within the first 10 minutes after use. If you notice this regularly, discuss this with your doctor.
• Using the wrong inhaler: Always check the label to make sure you are using the correct inhaler for your current treatment.
• Mouth or throat irritation: Rinse your mouth after use and use a spacer, if applicable. If not resolved, see your doctor.

Maintaining Your Inhaler

Proper maintenance is essential for ensuring your inhaler’s effectiveness and longevity. Follow these general guidelines, along with the specific manufacturer’s instructions:

• Regular Cleaning: Clean the mouthpiece of your inhaler, following the manufacturer’s directions at least weekly, and allow it to air dry. For spacers, clean after every use, and for DPIs wipe the outside with a dry cloth, and never wash these inhalers.
• Storage: Store your inhaler in a clean, dry place at room temperature and away from extreme heat or cold.
• Expiration Dates: Check the expiration date and replace the inhaler before it expires.
• Refills: Do not wait until you are out of doses to ask for a refill from your doctor. Have the refill prescription ready when you are low on medication.
• Keep Track of Doses: Many MDIs have built in counters or use an app. Use this to keep track of doses so you know when to refill.

Conclusion

Using your inhaler correctly is a fundamental part of managing your respiratory health. By mastering the proper technique for your specific inhaler, you can ensure that you’re getting the full benefit of your medication and improving your overall quality of life. Don’t hesitate to ask your doctor, pharmacist, or respiratory therapist to demonstrate the correct technique and answer any questions you may have. With practice and diligence, you can breathe easier and manage your respiratory condition effectively.