Asthma and COPD Inhalers: How to Use Them Right for Better Breathing

Most People Are Using Their Inhalers Wrong - And It’s Making Their Breathing Worse

If you or someone you know uses an inhaler for asthma or COPD, there’s a good chance it’s not working as well as it should. Studies show that 70 to 90% of people use their inhalers incorrectly. That means up to 90% of the medicine is never reaching the lungs - it’s stuck in the mouth, throat, or even sprayed into the air. The result? Wasted medication, ongoing symptoms, more flare-ups, and more trips to the ER.

This isn’t about being careless. It’s about complexity. Inhalers aren’t like swallowing a pill. They require timing, coordination, and specific breathing patterns. And with over 20 different types on the market, each with its own rules, it’s no wonder people get confused. The good news? Learning the right technique is simple - if you know what to do.

Three Main Types of Inhalers - And How They Work Differently

Not all inhalers are created equal. There are three main types, and each demands a different approach:

• Metered-Dose Inhalers (MDIs) - These are the most common. Think of them like tiny spray cans. You press down on the canister while breathing in. But here’s the catch: you have to press and breathe at the exact same time. If you’re too early or too late, the medicine hits your tongue instead of your lungs. Common brands include ProAir HFA and Ventolin HFA.
• Dry Powder Inhalers (DPIs) - These don’t use a propellant. Instead, you breathe in fast and hard to pull the powdered medicine into your lungs. Devices like Diskus, Turbuhaler, and Ellipta fall into this category. They’re easier for some because there’s no timing needed - but they won’t work if you can’t take a strong, deep breath. That’s a problem for many older adults or those with advanced COPD.
• Soft Mist Inhalers - These are newer. The Respimat device releases a slow, fine mist that stays in the air for about 1.5 seconds. You breathe in slowly, and the medicine has more time to reach your lungs. They’re less dependent on timing or breath strength, but still require proper form.

Here’s the key: the best inhaler is the one you can use correctly. A study in Respiratory Medicine found that only 23% of people could coordinate an MDI without training. If you struggle with timing, a DPI might seem easier - until you realize you can’t breathe hard enough. That’s why your doctor should help you pick the right one, not just prescribe the most popular.

How to Use an MDI the Right Way (Step-by-Step)

If you’re using a metered-dose inhaler, here’s what you need to do - every single time:

1. Remove the cap and shake the inhaler for 5 seconds.
2. Hold it upright, with the mouthpiece at the bottom.
3. Breathe out fully - away from the inhaler.
4. Place the mouthpiece in your mouth and seal your lips around it.
5. Press down on the canister at the very start of a slow, deep breath (like you’re sipping a thick milkshake through a straw).
6. Keep breathing in slowly for 3 to 5 seconds.
7. Hold your breath for 10 seconds - yes, count to 10. This lets the medicine settle into your airways.
8. Breathe out slowly through your nose.

And here’s the part most people skip: wait 60 seconds between puffs. If you need a second puff, don’t rush. Wait a full minute. That gives the medicine time to spread out and prevents you from overwhelming your lungs with too much at once.

Why Spacers Are a Game-Changer (And Why You Should Use One)

If you’re using an MDI, get a spacer - a plastic tube that attaches to the inhaler. It’s not optional. It’s essential.

A spacer holds the medicine in a chamber after you press the canister. That gives you time to breathe in slowly without needing perfect timing. Studies show spacers increase lung delivery by 70 to 100% compared to using an MDI alone. That’s the difference between getting 10% of your medicine and 60%.

Spacers are especially helpful for children, older adults, and anyone who struggles with coordination. But here’s the mistake: people use them with DPIs. Don’t. DPIs are designed to work without spacers. Adding one cuts the medicine delivery by 50-70%. It’s like putting a lid on a coffee maker - you’re blocking the flow.

DPIs: What You Need to Know Before You Use One

Dry powder inhalers sound simple - just breathe in hard. But there are hidden pitfalls:

• You must breathe in fast and deep - at least 60 liters per minute. If you’re weak from COPD, you might not be able to generate that force. That’s why many older patients struggle.
• Never open the device and try to see or touch the powder. It’s not meant to be handled. Opening capsules or shaking them out ruins the dose.
• Don’t breathe out into the device before inhaling. That blows the powder away.
• Some users report coughing or throat irritation because the powder sticks to the back of the throat. That’s a sign you didn’t inhale hard enough. Try again with a stronger breath.

A 2023 survey by the COPD Foundation found that 31% of users had coughing fits from powder getting stuck. That’s not normal - it’s technique failure. If you’re coughing after every puff, ask your provider to check your technique. You might need a different device.

Common Mistakes Everyone Makes (And How to Fix Them)

Here are the top mistakes - and how to avoid them:

• Not shaking the inhaler - 45% of users skip this. If you don’t shake, the medicine settles at the bottom. You’ll get a weak or uneven dose.
• Exhaling into the device - 27% of people breathe out into the mouthpiece before inhaling. That blows the medicine away.
• Not holding your breath - 63% of users exhale right after inhaling. Holding your breath for 10 seconds increases lung deposition by 20-30%.
• Using multiple inhalers without training - Switching between MDIs and DPIs without proper instruction cuts effectiveness by 35-50%. Stick to one type unless your doctor says otherwise.
• Storing inhalers in hot places - Keeping them in a car or bathroom cabinet (above 30°C) reduces potency by 15-20%. Store them at room temperature.

What to Do After You Use Your Inhaler

If your inhaler contains steroids - like fluticasone, budesonide, or beclomethasone - you must rinse your mouth after each use. Swish water or mouthwash, then spit it out. Don’t swallow it.

Why? Inhaled steroids can cause oral thrush - a fungal infection that looks like white patches in your mouth. Studies show rinsing reduces this risk by 75%. It’s a tiny step that prevents a big problem.

Also, never rinse your mouth before using the inhaler. That washes away the medicine before it even gets to your lungs.

When Your Inhaler Doesn’t Seem to Work - It’s Probably Not the Medicine

Many people think their inhaler isn’t working because their symptoms aren’t gone. But more often, the problem is technique. A Drugs.com analysis of 3,852 reviews found that 37% of users said they didn’t know if they were using it right - and 29% said the medicine “didn’t work.”

Before you assume you need a stronger dose or a new inhaler, ask yourself: Have I ever had someone watch me use it? Most patients only get one demonstration - if that - when they’re prescribed the device. But research shows you need three or more practice sessions with a provider to get it right.

Don’t be shy. Ask your doctor, nurse, or pharmacist to watch you use your inhaler - right now. Bring it to your next appointment. Show them. Let them correct you. It’s not embarrassing. It’s medical care.

Smart Inhalers Are Coming - But They Won’t Fix Bad Technique

There’s new tech: smart inhalers with sensors that track when and how you use them. Propeller Health’s device, approved by the FDA in 2021, can detect if you’re inhaling too slowly, too fast, or not holding your breath. It sends data to your phone.

But here’s the catch: these devices can’t teach you how to breathe correctly. They can only tell you that you’re doing it wrong. You still need to learn the technique from a human.

By 2025, 40% of inhalers may have digital tracking. That’s helpful - but it’s not a replacement for education. The real breakthrough will be when doctors use this data to personalize training, not just monitor usage.

Final Tip: Practice Like You Mean It

Using an inhaler isn’t something you learn once and forget. It’s a skill - like playing guitar or riding a bike. If you don’t practice, you lose it.

Take five minutes every week to go through the steps. Use a mirror. Watch yourself. Make sure your lips are sealed, your head is upright, and you’re breathing slowly. If you’re using a spacer, make sure it’s clean. Rinse it weekly with warm water and let it air dry.

And if you’re ever unsure - ask. Don’t guess. Your lungs can’t afford it.

Next Steps: Take Control of Your Breathing

Don’t wait for your next appointment to fix your technique. Bring your inhaler to your next doctor visit - and ask them to watch you use it. If they don’t offer, ask: “Can you watch me use my inhaler and tell me if I’m doing it right?”

Record yourself using it on your phone. Watch the video. Does your breath start before you press? Are you breathing too fast? Are you holding your breath? These are easy fixes - if you know what to look for.

Proper inhaler use isn’t about being perfect. It’s about being consistent. And when you get it right, you’ll feel the difference - fewer symptoms, fewer attacks, and more freedom to breathe without fear.