Asthma and COPD Inhalers: How to Use Them Correctly for Better Results

Millions of people with asthma or COPD rely on inhalers every day. But here’s the hard truth: if you’re not using your inhaler right, you might as well be breathing in air. Studies show that 70% to 90% of people get less than 30% of their medication into their lungs because of poor technique. That means your inhaler isn’t working - not because the medicine is weak, but because you’re not using it the way it was designed to be used.

Why Technique Matters More Than the Device

It doesn’t matter if you have the latest, most expensive inhaler. If you press the button too early, don’t hold your breath long enough, or inhale too fast, the medicine ends up stuck in your mouth or throat. That’s not just wasted medication - it’s a risk. Inhaled steroids can cause thrush, hoarseness, or even pneumonia if they sit in your mouth. And if you’re not getting enough medicine into your lungs, your symptoms won’t improve. You might end up using your rescue inhaler more often, or worse, wind up in the emergency room.

Research from the National Heart, Lung, and Blood Institute (NHLBI) shows that correct technique can double how much medicine reaches your lungs - from as low as 8% to as high as 60%. That’s not a small difference. That’s the difference between breathing easily and struggling to catch your breath.

Three Main Types of Inhalers - And How Each Works

There are three types of inhalers you’re likely to be prescribed. Each one works differently, and each requires a different technique.

• Metered-Dose Inhalers (MDIs) - These are the classic press-and-breathe devices. You’ll see them in brands like ProAir HFA or Ventolin. They use a propellant to spray out a puff of medicine. But here’s the catch: you have to press the canister and breathe in slowly at the exact same time. Most people mess this up. They press too early, too late, or breathe too fast.
• Dry Powder Inhalers (DPIs) - These include devices like the Diskus, Ellipta, and Turbuhaler. They don’t use propellant. Instead, they release a fine powder when you inhale quickly and forcefully. This sounds simple - until you realize you need to generate a breath flow of 60 to 90 liters per minute. That’s hard if you’re older, weak, or having a flare-up.
• Soft Mist Inhalers - The Respimat is the most common one. It doesn’t spray. It releases a slow, gentle mist over 1.5 seconds. This gives you more time to inhale, which helps if you struggle with timing. But you still need to breathe in slowly and deeply.

Here’s the surprising part: MDIs with a spacer deliver just as much - or even more - medicine than DPIs. A spacer is a plastic tube you attach to the inhaler. It holds the puff of medicine so you can breathe in slowly without timing it perfectly. The Global Initiative for Asthma (GINA) recommends spacers for everyone, especially children and older adults.

How to Use an MDI With a Spacer - Step by Step

If you’re using an MDI, this is the best way to make sure you get the full dose:

1. Shake the inhaler well - at least 5 shakes. Skipping this means the medicine isn’t mixed right. Studies show 45% of users forget this.
2. Attach the spacer. Make sure it’s clean and dry.
3. Breathe out fully - not into the spacer, just away from it.
4. Put the spacer mouthpiece in your mouth. Seal your lips around it.
5. Press the inhaler once to release one puff into the spacer.
6. Breathe in slowly and deeply through your mouth. Count to 5 as you inhale.
7. Hold your breath for 10 seconds. This lets the medicine settle in your lungs. Most people exhale too soon - cutting effectiveness by 20-30%.
8. Breathe out slowly.
9. If you need a second puff, wait at least 60 seconds before repeating.

And don’t forget: rinse your mouth with water and spit it out after using any steroid inhaler. It cuts your risk of oral thrush by 75%.

How to Use a Dry Powder Inhaler - What Most People Get Wrong

DPIs are popular because they’re easier to carry and don’t need a spacer. But they have their own traps.

• Never exhale into the device. If you blow into it before inhaling, you’ll ruin the powder. It clumps and won’t reach your lungs.
• Inhale fast and hard. You need to create a strong, deep breath - not a slow one. If you’re weak or tired, this can be hard. That’s why many older patients struggle.
• Don’t open the capsule. Some DPIs use capsules you load. Never, ever open them. The powder is meant to be inhaled from the capsule. 15% of users try to open them - and end up wasting their dose.
• Don’t use a spacer. Spacers don’t work with DPIs. They trap the powder. The Cleveland Clinic says this cuts effectiveness by 50-70%.

If you’re using a DPI and still coughing or feeling the powder in your throat, you’re probably breathing too slowly. Try standing up, taking a big breath from your belly, and then inhaling sharply through the mouthpiece.

Common Mistakes - And How to Fix Them

Here’s what most people do wrong - and how to fix it:

• Not shaking the inhaler - Always shake it. Even if it feels like there’s no liquid inside.
• Not holding breath long enough - Aim for 10 seconds. Set a mental timer. If you can’t count to 10, try saying "elephant" slowly - that’s about 10 seconds.
• Exhaling into the device - Always breathe out first, then inhale.
• Using multiple inhalers without training - Switching between MDIs and DPIs without practice causes confusion. The European Respiratory Society says this reduces effectiveness by 35-50%.
• Storing inhalers in hot places - Keep them at room temperature. Above 30°C, the medicine loses 15-20% of its strength.

What to Do If Your Inhaler Isn’t Working

If you’ve been using your inhaler the same way for years and still feel short of breath - you’re not alone. But you’re not stuck.

Ask your doctor or pharmacist to watch you use it. Don’t be embarrassed. Most professionals expect this. The UK Inhaler Group says the average patient needs three practice sessions to get it right. Some need five. That’s normal.

Also, ask if you’re on the right device. If you’re older or have severe COPD, a DPI might be too hard. An MDI with a spacer could be better. If you’re young and active, a DPI might be more convenient. Your doctor should help you choose based on your strength, coordination, and lifestyle - not just what’s cheapest.

Technology Is Helping - But It’s Not a Replacement

New smart inhalers like the one from Propeller Health track when you use your inhaler and whether your technique is correct. A 2022 study found they’re 92% accurate. That’s impressive. But they don’t fix technique - they just tell you you’re doing it wrong. You still need to learn how to breathe right.

By 2025, 40% of inhalers will have some kind of digital feedback. But until then, your best tool is still your doctor, a spacer, and practice.

Final Advice: Don’t Guess. Get Checked.

Inhalers are powerful tools - but only if you use them right. The good news? You can fix this. You don’t need to be a medical expert. You just need to know the steps.

Here’s what to do next:

• Watch a video from the American Lung Association or NHLBI - they have free, clear tutorials.
• Ask your pharmacist to show you how to use your specific device. Do it in front of them.
• Practice in front of a mirror. Watch your lips, your breath, your timing.
• Set a reminder: every 3 months, review your technique. Even if you feel fine.

Proper inhaler use isn’t about following rules. It’s about getting the medicine where it needs to go - into your lungs - so you can breathe easier, sleep better, and live without fear.

Next Steps: Take Control

You don’t need to be perfect. You just need to be consistent. Start today: watch a video, ask your pharmacist, practice in front of a mirror. In three months, you’ll notice the difference - fewer coughing fits, less wheezing, more freedom. Your lungs don’t care about the brand of your inhaler. They only care if the medicine gets to them.