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7 Ways People Misuse Their Inhalers

Are you using your asthma inhaler the right way? I mean, how hard can it be, right?!

I’m at the airport waiting for my flight, and I watched the woman across from me start to cough violently and then use her inhaler. My husband leaned over and said, “She didn’t use that right. She doesn’t have a spacer.” I answered, “And she didn’t wait one minute between puffs!”

As a Certified Asthma Educator (AE-C), should I have approached her and corrected her technique? Well, some people are Happy Travelers and some… aren’t. And some people don’t like others telling them what to do. So I’ll share a little info here. These are the Top 7 Mistakes I see when I work with families.

1. Not checking the opening of the inhaler for debris.

Depending on where you keep your asthma inhaler, the opening can collect all sorts of things – dimes, lint, crumbs, etc. Always check the opening! I heard of a woman who pulled her inhaler out of her purse, didn’t check the opening and inhaled a dime that was stuck in the inhaler. I have a family member who keeps his inhaler in his pocket and he inhaled – you guessed it – lint.

2. Not priming your inhaler

If you drop your inhaler, or it hasn’t been used in 2 weeks, you must prime it. This varies by brand, but most manufacturers recommend priming your inhaler by spraying the inhaler 1-4 puffs BEFORE you use it. You may need to look up your brand of inhaler and see how many puffs you need to spray to prime it. This makes sure you get the right amount of medication.

3. Not shaking your inhaler before use

You must shake your inhaler to mix the medicine and propellant. Kind of like how you shake up a can of spray paint before you use it.

4. Not exhaling BEFORE your use your inhaler

You need to breathe out first so there’s room in your lungs to take a nice deep breath and inhale all that lovely medicine.

5. Not using a spacer/holding chamber

Best practice recommends using a spacer (tube-like device) that attaches to your asthma inhaler. You spray your inhaler into the spacer/holding chamber which will “hold” the medicine until you breathe it in. It can be easier for people that can’t coordinate when to spray the inhaler and when to breathe in. (I have no coordination –  in fact, I can hardly chew gum and walk at the same time! So I use a spacer.)

NOTE: If you don’t use a spacer, you may need to use a different inhaler technique. You would start to breathe in FIRST (with the inhaler in your mouth and lips closed around it) and THEN press down on the inhaler. Since you are already breathing in, it’s easier to pull the medicine down into your lungs. If you spray it and then try to breathe in, most of the medicine can end up in the back of your throat.

6. Wait one minute between puffs

A pharmacist told me there are a couple of reasons why. The 1st puff will go about halfway through the lungs and stop. (Your lungs branch out 28 times – like tree branches – so the medicine has a long way to go.) Since the 1st puff has cleared a path, that makes it easier for the 2nd puff to quickly travel through the first part of lungs, then plow through to the end of the lungs. The other reason is that it gives the propellant and medicine time to swirl around and mix.

7. Not rinsing your mouth after you use your controller inhaler

Have you ever heard of thrush? It’s an uncomfortable fungal infection on the tongue. Your tongue can turn white and can get red spots on it which can bleed. Food may also taste a little “off.” Controller inhalers are made with a yeast base, so if you don’t rinse your mouth out, you can get thrush.

Good technique is so important to make sure you are getting ALL of the medicine you need!

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This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.


  • Elizabeth 1991
    2 years ago

    well i do all that except the spacer

  • Leon Lebowitz, RRT moderator
    2 years ago

    Hi again Elizabeth 1991. If you are using your metered dose properly and are successful with it, you may not need the spacer at all.
    Warm regards,
    Leon (site moderator)

  • emmejm
    2 years ago

    Ugh… I remember, in college, seeing one of my residents (I was an RA) do the “puff puff gasp” with her albuterol. When I mentioned it to her in a nice, non-condescending manner, she said, “Nope, this is how my doctor told me to use it!” I bit my tongue and didn’t tell that if her doctor truly said that, she needed a new doctor but it was a close one…

  • Leon Lebowitz, RRT moderator
    2 years ago

    Hi emmejm – as an RA, you were probably being as discreet as you possibly could be in holding your remarks. It’s not uncommon for us to see that many health care professionals do NOT know the proper way to use inhalers. I sure hope that by now, that resident you were looking out for has found her way!!
    All the best,
    Leon (site moderator)

  • Leon Lebowitz, RRT moderator
    2 years ago

    Hi Andrea – and thanks for the article, it provides a good guideline in how to use our inhalers properly by knowing exactly what not to do!

    I’ve always been puzzled by the recommendation (by the manufacturer) to ‘prime’ the inhaler. We all know it can be necessary and that it actually works by insuring the proper dose is dispensed with each actuation of the device.

    It strikes me this ‘design flaw’, can use up precious medication which can then result in having to buy another inhaler sooner than expected.

    As said, it’s always puzzled me the manufacturer has built this into their ‘sales’ program.

    Food for thought…
    Leon (site moderator)

  • Andrea M Jensen, CHES (R), AE-C author
    2 years ago

    Agreed! Many people struggle with that. Since I use a daily controller, I don’t need my albuterol as often as some people may. As you probably know, “The Rules of 2’s” say that using your Albuterol more than twice a week means your asthma is uncontrolled. Since I don’t need my inhaler that often, mine will usually expire before I use all of the puffs.

    It does seem a waste of medicine to prime it that many times though. I’m sure the drug companies have a scientist reason for that?

  • portugal818
    2 years ago

    I so agree. I’ve been using ProAir for years. My last inhaler had some kind of flaw in top and I couldn’t trust it to dispense a needed dose — kept sticking. Called Teva who instructed me to rinse top part thoroughly and “prime” before using. I changed to an old top but of course I could no longer keep track of doses remaining in canister or trust that it would work if I needed emergency dose when away from a sink. I must have “primed” away1/4 of the doses. Teva told me they would NOT replace this medication. Just not their policy — even for a customer of probably 15 years. A little miffed and concerned.

  • Leon Lebowitz, RRT moderator
    2 years ago

    I don’t blame you one bit, portugal818, for feeling the way you do. I’ve always wondered AND questioned that manufacturers recommend ‘priming the inhaler’ knowing that the procedure itself actually utilizes/expends precious medication in an effort to insure the proper dosage per actuation.
    It’s so incongruous for and inconsiderate of the patient.
    All the best,
    Leon (site moderator)

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