Most people with asthma or COPD rely on inhalers to breathe easier. But here’s the hard truth: if you’re not using your inhaler correctly, you’re probably getting less than a third of the medicine you paid for. Studies show 70 to 90% of patients use their inhalers wrong - and that’s not because they’re careless. It’s because no one ever showed them how to do it right.
Why Technique Matters More Than the Device
You might think the brand or type of inhaler makes the biggest difference. It doesn’t. What matters more is how you use it. A 2022 study in Respiratory Medicine found only 23% of people could press the inhaler and breathe in at the same time without training. That’s not a skill you pick up by reading the box. It’s something you learn - and most people never do.
When you use your inhaler wrong, the medicine hits your throat or mouth instead of your lungs. That’s why you might feel like it’s not working. You’re not getting the full dose. You’re just swallowing a puff of powder or spray. The result? More coughing, more wheezing, more trips to the ER.
Here’s the good news: getting it right doesn’t take magic. It takes practice - and knowing what to look for.
The Three Main Types of Inhalers (And How They Work)
Not all inhalers are made the same. There are three main types, and each needs a different approach.
- Metered-Dose Inhalers (MDIs): These are the classic spray cans - like ProAir HFA or Ventolin. They release a puff of medicine when you press down. But here’s the catch: you have to press it and breathe in slowly at the same time. If you press too early or too late, the medicine just flies out and lands on your tongue.
- Dry Powder Inhalers (DPIs): These include Diskus, Turbuhaler, and Ellipta. No spray here. You breathe in fast and hard, and the powder gets pulled into your lungs. But if you’re too weak, too slow, or too gentle - which is common in older adults or during a bad flare - the powder won’t lift off. It sticks in your throat. That’s why 31% of COPD users report coughing fits after using DPIs.
- Soft Mist Inhalers: Like Respimat. These release a slow, gentle mist that lasts 1.5 seconds. They’re easier to coordinate than MDIs, but still need a deep breath. They’re not as common, but they’re a good option if you struggle with timing or strength.
Here’s the key: MDIs work best with a spacer. A spacer is a plastic tube that attaches to the inhaler. It holds the puff in a chamber so you can breathe in at your own pace. Studies show spacers boost lung delivery by 70-100%. That’s like getting two puffs for the price of one. DPIs? Never use a spacer with them. It blocks the airflow and cuts effectiveness by half.
How to Use an MDI (With Spacer) - Step by Step
If you use an MDI, here’s what you need to do - every single time:
- Remove the cap and shake the inhaler for 5 seconds.
- Attach it to the spacer. Make sure it’s snug.
- Breathe out fully - away from the spacer.
- Place the spacer mouthpiece in your mouth and seal your lips around it.
- Press the inhaler once to release the puff into the spacer.
- Breathe in slowly through your mouth for 3-5 seconds. Don’t rush.
- Hold your breath for 10 seconds. This lets the medicine settle in your lungs.
- Breathe out slowly through your nose.
Wait at least 60 seconds before taking a second puff. If you’re using a corticosteroid inhaler (like fluticasone or budesonide), rinse your mouth with water and spit it out. This cuts your risk of oral thrush by 75%. Don’t swallow the rinse.
How to Use a DPI - Step by Step
For dry powder inhalers, forget slow and gentle. You need power.
- Load the dose as instructed (some need you to slide a lever, others twist a base).
- Hold the inhaler upright - never point it down.
- Breathe out fully - away from the device.
- Place the mouthpiece in your mouth and seal your lips.
- Breathe in quickly and deeply - like you’re trying to suck a thick milkshake through a straw.
- Hold your breath for 10 seconds.
- Breathe out slowly.
Never open the capsule or try to shake the powder out. That’s a common mistake - 15% of users do it, and it ruins the dose. Also, don’t breathe into the device before inhaling. That gets the powder wet and clumpy. And don’t use it if your hands are wet - moisture kills the powder.
Common Mistakes (And How to Fix Them)
Here’s what most people get wrong - and how to fix it:
- Not shaking the MDI: 45% skip this. Shake it for 5 seconds before every puff. The medicine settles at the bottom.
- Exhaling into the inhaler: You’re blowing out the medicine before you even start. Always breathe out away from the device.
- Not holding your breath: 63% of users exhale right after inhaling. Hold for 10 seconds. It’s the difference between 10% and 40% of the medicine reaching your lungs.
- Using the wrong head position: Tilt your head back slightly - not too far, not too little. A straight line from your mouth to your lungs works best.
- Storing inhalers in hot places: Keep them at room temperature (20-25°C). Heat above 30°C reduces potency by 15-20%.
Who Should Use What? A Simple Guide
Not every inhaler fits every person. Here’s a quick match:
| Profile | Best Choice | Why |
|---|---|---|
| Adults with good lung strength | MDI with spacer or DPI | Both work well. Spacer makes MDI more reliable. |
| Older adults (65+) | MDI with spacer | 62% struggle with DPIs due to weak breath. Spacers remove the need for forceful inhalation. |
| During an asthma attack | MDI with spacer | DPIs need strong breath - which you won’t have during a flare. |
| Children under 6 | MDI with spacer and mask | They can’t coordinate breath or hold still. Spacer + mask works better. |
| People with tremors or arthritis | DPI or soft mist inhaler | No need to press a button. Just breathe in. |
Don’t switch devices without talking to your doctor. Using two different inhalers without training increases the chance of mistakes by 35-50%.
Smart Inhalers Are Here - But They’re Not Magic
There’s a new wave of inhalers with built-in sensors - like Propeller Health. They track when you use your inhaler and even detect if your technique is off. One 2022 study found they’re 92% accurate at spotting bad technique.
But here’s the catch: they don’t fix the problem. They just tell you it’s there. You still have to learn how to do it right. These devices are helpful for people who forget doses or need reminders - but they’re not a replacement for hands-on training.
By 2025, 40% of inhalers are expected to have digital tracking. That’s great - but only if we also fix the training gap.
What Your Doctor Should Be Doing
Every time you see your doctor for asthma or COPD, they should ask: “Can you show me how you use your inhaler?”
The National Asthma Education and Prevention Program says this check should happen at every visit. And it works: patients who get technique checks have 22% fewer ER visits.
If your doctor doesn’t ask - ask them. Bring your inhaler to the appointment. Practice in front of them. Don’t assume they know you’re doing it right. Most don’t.
Real Stories From Real Users
On Reddit, one user wrote: “I’ve been using my inhaler for 12 years. Last year, my nurse showed me how to use a spacer. I haven’t needed my rescue inhaler once since.”
Another said: “I thought my DPI wasn’t working. Turns out I was breathing too slow. Once I learned to suck hard, my symptoms dropped.”
And a 72-year-old man from Perth: “I used to cough for 10 minutes after my inhaler. Now I rinse my mouth, hold my breath, and I’m fine. I wish I’d known this 20 years ago.”
These aren’t rare cases. They’re the norm.
What You Can Do Today
You don’t need to wait for your next appointment. Here’s what to do now:
- Grab your inhaler and spacer (if you have one).
- Watch a 3-minute video from the American Lung Association or National Asthma Council Australia. Search “proper inhaler technique” on YouTube - stick to official health channels.
- Practice in front of a mirror. Watch where the spray goes. If it hits your tongue, you’re doing it wrong.
- Ask a family member to watch you. They’ll catch things you miss.
- Call your pharmacy. Many offer free inhaler technique checks.
It takes 3-4 tries to get it right. Don’t give up. This isn’t about being perfect. It’s about getting enough medicine into your lungs so you can breathe without fear.
Final Thought: Your Lungs Are Waiting
You’ve spent money on your inhaler. You’ve trusted your doctor. But the real power is in your hands - literally. The right technique turns a simple device into a life-changing tool. The wrong technique turns it into a waste of time, money, and breath.
Don’t let poor technique be the reason your symptoms won’t improve. Learn it. Practice it. Teach someone else. Because breathing shouldn’t be a guess.
How do I know if I’m using my inhaler correctly?
You can’t always tell by how you feel - many people think they’re using it right when they’re not. The best way is to ask your doctor or pharmacist to watch you use it. You can also record yourself with your phone and compare it to a trusted video from the American Lung Association or National Asthma Council Australia. Look for signs like medicine hitting your tongue, coughing right after use, or needing your rescue inhaler too often.
Can I use a spacer with a dry powder inhaler?
No. Spacers are only for metered-dose inhalers (MDIs). Using a spacer with a dry powder inhaler (DPI) blocks the airflow needed to lift the powder into your lungs. Studies show this cuts effectiveness by 50-70%. Always use the right tool for the right device.
Why do I still cough after using my inhaler?
Coughing after using an inhaler usually means the medicine is landing in your throat instead of your lungs. This happens with both MDIs (if you don’t coordinate the puff and breath) and DPIs (if you don’t inhale fast enough). Rinsing your mouth after corticosteroid inhalers helps reduce throat irritation. If you keep coughing, ask your doctor to check your technique - it’s likely the issue.
Should I use my inhaler before or after exercise?
If you have exercise-induced asthma, use your rescue inhaler (like albuterol) 15-30 minutes before starting. This opens your airways before the activity. Don’t use it after - it’s too late. For daily controller inhalers (like corticosteroids), take them as prescribed, usually at the same time each day, regardless of exercise.
How often should I clean my inhaler?
Clean your MDI mouthpiece once a week. Remove the metal canister, rinse the plastic cap and mouthpiece under warm water, and let it air-dry overnight. Never rinse the canister or put it in the dishwasher. For DPIs, wipe the mouthpiece with a dry cloth - don’t use water. Moisture ruins the powder. Always check your device’s instructions - some have specific cleaning rules.
What if I miss a dose of my controller inhaler?
If you miss a dose of your daily controller inhaler (like fluticasone or budesonide), take it as soon as you remember - unless it’s almost time for the next dose. Never double up. Missing doses doesn’t cause immediate symptoms, but it lets inflammation build up over time. That’s when flare-ups happen. Consistency matters more than perfection.
Can children use inhalers the same way as adults?
No. Children under 6 can’t coordinate breathing with an MDI. They need a spacer with a face mask. Older children can use MDIs with spacers, but still need supervision. DPIs are usually not recommended for kids under 6 because they can’t generate enough breath force. Always ask your pediatrician for the right setup - and make sure the school or daycare knows how to help.