How to use an inhaler

The following originally published at healthcentral.com/asthma on 4/15/14. 

How to properly use an inhaler

While most asthma and chronic obstructive pulmonary disease (COPD) patient are familiar with the little blue asthma inhaler called albuterol, studies show that as many as 85 percent use it incorrectly, with at least 40 percent making at least one essential mistake.

So, chances are most of us could benefit from a rescue inhaler refresher course.

When asked to give me a demonstration of how they use their inhaler, many of my patients do something like this:

• Stuff the inhaler in their mouth 
• Squirt the inhaler while inhaling 
• Exhale some of the mist 

Using poor technique like this simply wastes most of the medicine. Some of it is exhaled, but most of it impacts in the upper airway. Then it's swallowed, resulting in less benefit and more side effects.

The best technique of using an inhaler is to use a spacer. The experts at nationaljewish.org describe the procedure.

• Insert the inhaler/canister into spacer and shake. 
• Breathe out. 
• Put the spacer mouthpiece into your mouth. 
• Press down on the inhaler once. 
• Breathe in slowly (for 3-5 seconds). 
• Hold breath for 10 seconds.

Why use a spacer? 

1. They improve coordination 
2. Large particles stay in the spacer so only fine particles enter your airway
3. Many have whistles to teach you to take a slow, deep breath 
4. The medicine smoothly passes through your upper airway to your lungs 
5. Studies show spacers make the medicine work 75% better than without it 
6. Less medicine impacts into your upper airway, greatly reducing side effects 
7. Studies show that proper use of an inhaler with a spacer makes the medicine work just as a nebulizer

Since spacers are proven to work so well, why do most people not use them? There are basically three reasons. 

• Poor training: Patients are not taught best technique 
• Forgetfulness: Patients are taught but use their inhaler so infrequently that they forget 
• Spacers are large, bulky, and inconvenient: This is the most common reason especially among men, as they can't just carry a spacer in their pockets. 

Especially while at home, it's best to keep the inhaler with a spacer. However, since most of us don't always have a spacer, it's important to know the second best technique, which is shown at nationaljewish.org:

• Remove the cap from the inhaler. 
• Hold the inhaler with the mouthpiece at the bottom. 
• Shake the inhaler. This mixes the medication properly. 
• Open Mouth Technique - Hold the mouthpiece 1½ - 2 inches (2 - 3 finger widths) in front of your mouth. Close Mouth Techinque - Seal your lips tightly around the inhaler mouthpiece. (Personally, the close mouth technique is the worse technique, and I would not recommend it) 
• Tilt your head back slightly and open your mouth wide. 
• Gently breathe out. 
• Press the inhaler and at the same time begin a slow, deep breath. Continue to breathe in slowly and deeply over 3 - 5 seconds. Breathing slowly delivers the medication deeply into the airways. 
• Hold your breath for up to ten seconds. This allows the medication time to deposit in the airways. 
• Resume normal breathing. 
• Repeat steps 3 - 9 when more than one puff is prescribed. 

In most instances, two puffs are recommended. Ideally, the first puff opens up the lungs, and the second puff does the mop up job. Most experts recommend allowing 1-5 minutes for the first puff to work before inhaling the second puff.

So there's your quick how to use an albuterol inhaler refresher course. We hope this helps you get the most of your rescue inhaler.

Related videos: 

• How to use an inhaler without a spacer
• How to use an inhaler with a spacer