Published on June 11, 2019

Using an inhaler? You’re probably doing it wrong.

Using inhaler

It seems simple enough: put an inhaler in your mouth and take a breath.

But far too many people who use rescue or controller inhalers needing more than one dose don’t wait long enough between puffs, according to a recent study published in the Journal of Allergy and Clinical Immunology. Many researchers say 30 seconds is the minimum time between inhalations, according to the study, which found that 84 percent of users didn’t wait that long and more than half didn’t even wait 15 seconds.

“If you’re not using an inhaler correctly, you’re not getting the recommended dose of medicine to keep the disease well controlled,” said Paul Evans, MD, a pulmonologist who practices in Hyannis.

The most common types of inhalers are controllers, which are designed for daily use to keep asthma at bay, and rescue inhalers, for people with intermittent symptoms.

There are several ways that people might use them incorrectly, said Dr. Evans.

“The first is that they don’t use correct breathing techniques to actually inhale the prescribed amount of medicine. The second is people often don’t take the correct number of doses. And third, people will often forget to take the second medicine in a twice-a-day dosing regimen.”

How to Use an Inhaler

To use a metered-dose inhaler without a spacer, follow these instructions from the National Institutes of Health:

  • Shake the inhaler hard before each use
  • Take the cap off and look inside the mouthpiece to make sure it is clear
  • Breathe out all the way, pushing as much air out as possible.
  • Hold the inhaler with the mouthpiece down, placing your lips around it to form a tight seal.
  • Breathe in slowly. As you start to breathe in through your mouth, press on the inhaler one time.
  • Keep breathing in slowly as deep as you can.
  • If you can, hold your breath as you slowly count to 10.
  • Breathe out slowly through your lungs.
  • After using the inhaler, rinse your mouth with water, gargle and spit.

Since technique is important, Dr. Evans and his nurses use inhalers with placebos to demonstrate correct use for new patients. Sometimes it’s a little tricky.

“With some of the inhalers you have to press a button and inhale at the same time,” he said. “Sometimes people have things like arthritis that make it difficult for them to handle the inhaler or even open the cover. Some people with advanced lung disease don’t have enough lung strength to use an inhaler.”

Those factors and others influence the type of inhaler prescribed for a patient. It’s important for patients to let their doctor know if they’re confused about how to use it – and to be honest if they’re not always following the guidelines.

“If you are not using your inhaler as prescribed, that’s not something to be ashamed of,” he said. “That’s very helpful information to help your provider find a better technique or a better device.”

The risk is that people who use an inhaler improperly and don’t get satisfactory results could end up being prescribed a stronger drug or a different regimen when the one they started with could have worked for them.

“If you're giving the provider misleading information, then you're not going to get the best results,” said Dr. Evans. “You're only hurting yourself.”

The study in the Journal of Allergy and Clinical Immunology found that poor inhaler technique happened at all ages.

“We were shocked in terms of the patterns of medication administration that appear to be contrary to how we teach that medications should be administered,” Dr. Stanley Szefler, a co-author of the study and the director of the pediatric asthma research program at Children’s Hospital Colorado, told The New York Times.

Children ages 4-11 did best and young people ages 18-29 did worst.

“Perhaps it’s because young kids are good at following directions,” said Dr. Evans.