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

Over 470 million people worldwide live with asthma or COPD. For many, an inhaler is the difference between breathing normally and struggling for air. But here’s the hard truth: 70 to 90% of people use their inhalers wrong. That means most of the medicine never reaches their lungs. It’s not the device’s fault. It’s the technique.

Why Your Inhaler Might Not Be Working

You take your inhaler like clockwork. You feel like you’re doing everything right. But your symptoms don’t improve. Your rescue inhaler runs out faster than it should. You keep getting coughing fits or throat irritation. The problem isn’t that the medicine is weak-it’s that it’s not getting where it needs to go.

Studies show that when technique is poor, only 8-30% of the dose actually lands in your lungs. That’s less than a third. With perfect technique, that jumps to 40-60%. That’s not a small difference. It’s the difference between staying out of the ER and needing emergency care.

The reason? Most people don’t know how to use their inhaler properly. And doctors rarely check. A 2023 JAMA Internal Medicine study found that patients who had their inhaler technique reviewed at every visit had 22% fewer emergency trips. That’s not magic. That’s just making sure the medicine works.

The Three Main Types of Inhalers

Not all inhalers are the same. There are three main types, and each works differently. Using the wrong method for your device means wasted medicine.

• Metered-Dose Inhalers (MDIs) - These are the classic canisters you shake and spray. Examples: ProAir HFA, Ventolin HFA. They use a propellant to push out a puff of medicine. You have to press the canister and breathe in at the exact same time. If you’re too early or too late, most of the dose hits your throat instead of your lungs.
• Dry Powder Inhalers (DPIs) - These don’t need a propellant. You breathe in hard and fast to pull the powder into your lungs. Examples: Diskus, Turbuhaler, Ellipta. They’re easier for some people because there’s no timing to coordinate. But if you can’t take a strong, fast breath-like if you’re having a bad flare-up or are older-this device won’t work well.
• Soft Mist Inhalers - These are newer. They create a slow, fine mist that lasts about 1.5 seconds. Example: Respimat. You don’t need to time your breath as precisely. They’re good for people who struggle with coordination, but they’re not as widely available.

Here’s the catch: MDIs with a spacer are more effective than DPIs for most people. A spacer is a plastic tube you attach to the inhaler. It holds the puff so you can breathe in slowly. It cuts down on throat irritation and boosts lung delivery by 70-100%. The National Asthma Council Australia and the Global Initiative for Asthma (GINA) both recommend spacers for everyone using MDIs-even adults.

How to Use an MDI Correctly (With Spacer)

If you’re using a metered-dose inhaler, here’s the step-by-step that actually works:

1. Remove the cap and shake the inhaler well for 5 seconds.
2. Attach the spacer. Make sure it’s clean and dry.
3. Breathe out fully-away from the spacer.
4. Place the spacer mouthpiece between your teeth and seal your lips around it.
5. Press the inhaler once to release one puff into the spacer.
6. Breathe in slowly through your mouth over 3-5 seconds. Don’t rush.
7. Hold your breath for 10 seconds. This lets the medicine settle in your airways.
8. Breathe out slowly.
9. If you need a second puff, wait 60 seconds before repeating.

Common mistakes? People skip shaking the inhaler (45% do this). They breathe in too fast. They don’t hold their breath. They exhale into the spacer before pressing the canister. All of these kill effectiveness.

How to Use a Dry Powder Inhaler (DPI)

DPIs don’t need a spacer. In fact, using one with a DPI cuts effectiveness by 50-70%. Here’s how to use them right:

1. Load the dose as instructed. For Diskus or Ellipta, slide the lever until you hear a click. For Turbuhaler, twist the base until it clicks.
2. Breathe out fully-away from the device. Never exhale into the mouthpiece.
3. Put the mouthpiece in your mouth and seal your lips.
4. Breathe in quickly and deeply-like you’re trying to suck a thick milkshake through a straw.
5. Hold your breath for 10 seconds.
6. Breathe out slowly.

Biggest mistake? People breathe in too slowly. DPIs need force. If you’re tired, weak, or having a bad day, you might not generate enough airflow. That’s why many older adults or people with severe COPD struggle with DPIs. A 2022 study from the National Asthma Council Australia found 62% of patients over 65 couldn’t use DPIs effectively. If you’re struggling, ask your doctor about switching to an MDI with a spacer.

What You Should Never Do

Some habits seem harmless. They’re not.

• Never remove the capsule from a DPI. The powder is designed to be inhaled from the device. Opening it and trying to inhale the powder directly? You’ll get none of the dose. About 15% of users try this-per Allergy & Asthma Network.
• Never rinse your mouth after using a rescue inhaler. Only rinse after using corticosteroid inhalers (like fluticasone or budesonide). Rinsing reduces oral thrush risk by 75%. Skip this, and you could develop a yeast infection in your mouth.
• Don’t store your inhaler in the bathroom. Heat and humidity kill medicine. The FDA says storing above 30°C reduces effectiveness by 15-20%. Keep it in a cool, dry place-like your bedroom drawer.
• Don’t use multiple inhalers without training. Switching between MDIs, DPIs, and soft mist devices without learning each one? You’ll mess up technique. The European Respiratory Society says this cuts effectiveness by 35-50%.

When to Call Your Doctor

You don’t need to wait until you’re in crisis. Here are signs your inhaler technique might be off:

• Your inhaler runs out faster than it should.
• You still feel tightness or wheezing after using it.
• You get frequent throat irritation, hoarseness, or a bad taste.
• You’ve never had your technique checked by a nurse or doctor.
• You’re unsure if you’re even getting the medicine.

Ask for a demonstration. Bring your inhaler to your next appointment. Ask: “Can you watch me use this?” Most doctors will say yes. If they don’t, ask for a respiratory therapist. They specialize in this.

The Future Is Smart

Technology is catching up. In 2021, the FDA approved the first smart inhaler sensor-Propeller Health-that clips onto your device and tracks when and how you use it. It even tells you if your inhalation was too weak or too fast. A 2022 study in Annals of Internal Medicine found it was 92% accurate.

By 2025, 40% of inhalers are expected to include digital tracking. That’s huge. It means your doctor will know if you’re using it right-not just if you’re using it at all.

But here’s the thing: no smart device fixes bad technique. It just shows you that you’re doing it wrong. The real fix? Learning how to breathe right.

Final Tip: Practice Like You Mean It

You wouldn’t drive a car without learning how to shift gears. Why treat your inhaler any differently?

Practice in front of a mirror. Watch your lips seal. Watch your breath. Use a spacer. Hold your breath. Do it slowly. Do it again.

YouTube has good videos. But don’t just watch-do it. Try it three times in a row. Then ask someone to watch you.

Your lungs don’t care how much the inhaler costs. They don’t care if it’s branded or generic. They only care if the medicine gets there.

And if you’re not getting it right? You’re not failing. You’re just untrained.