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Asthma: correct use of your aerosol inhaler

Did you know that 90% of the medication from metered dose inhalers (also known as puffers) sticks to your mouth and does not reach your lungs?

Why all the fuss about inhalers?

It is very important to use your inhaler correctly so that the medication in the spray reaches deeply into your lungs to treat your asthma. A faulty inhaler technique is a common cause for medication not working properly. It is important to know that it is your inhalation effort- not the pressure from the aerosol pushing in-that gets the medication into your lungs. Why not ask your doctor to check you using your inhaler?

What are the two main techniques?

The open mouth technique and the closed mouth technique are the main techniques, and both are effective. Choose the technique that suits you best.

Both techniques are suitable for most adults. Most children from age 7 can learn to use puffers quite well.

The open mouth technique

1. Remove the cap. Shake the puffer vigorously for 1-2 seconds. Hold it upright (canister on top) to use it ( as shown ).
2. Hold the mouthpiece of the puffer 4-5 cm (about 3 fingers' breadth) away from your mouth.
3. Tilt your head back slightly with your chin up. Open your mouth and keep it open.
4. Slowly blow out to a comfortable level.
5. Just as you then start to breathe in (slowly) through your mouth, press the puffer firmly, once. Breathe in as far as you can over 3-5 seconds. (Do not breathe in through your nose.)
6. Close your mouth and hold your breath for about 10 seconds; then breathe out gently.
7. Breathe normally for about 1 minute, and then repeat the inhalation.

The closed mouth technique

The method is basically identical to the open mouth technique except that you close your lips around the mouthpiece.

Common mistakes

• holding the puffer upside down
• holding the puffer too far away
• pressing the puffer too early and not inhaling the spray deeply
• pressing the puffer too late and not getting enough spray
• doing it all too quickly: not breathing in slowly and holding your breath
• squeezing the puffer more than once
• not breathing in deeply

Large volume spacers

Some people who have trouble using inhalers can have a special 'spacer' fitted onto the mouthpiece of the inhaler. I or 2 puffs of the aerosol are put in the spacer. Then you breathe in from its mouthpiece. Take 1 deep inhalation then 1-2 normal breaths, or take 4-6 normal sized breaths. This method is useful for adults having trouble with the puffer and for younger children (older than 3). Spacers are very efficient and cause less irritation of the mouth and throat.

Extra points

1. The usual dose of a standard metered dose aerosol is 1 or 2 puffs every 3-4 hours for an attack.
2. If you do not get adequate relief from your normal dose, you should contact your doctor.
3. It is quite safe to increase the dose, such as to 4-6 puffs.
4. If you are using your inhaler very often, it usually means your other asthma medication is not effective or is not being used properly. Discuss this with your doctor.

Copyright 1995: John Murtagh, Professor of General Practice
Monash University, Melbourne, Australia