Answers to Asthma Questions I Didn't Know I Had: Inhaler Technique

“That’s just how it is,” or “because I said so,” are, in my world, not answers when I have questions. I am naturally inquisitive, and while I can accept I don’t know for an answer, it’s harder for me to accept the “that’s just the way it’s always been,” type responses. Sometimes though, I don’t even know that I have questions until I read the answers—and then I get a very specific type of nerd rush of knowledge joy. Then, of course, my brain runs amok with more questions that demand answers.

I present to you, the first (and maybe last) episode of Answers to Asthma Questions I Didn’t Know I Had, entitled Inhaler Technique.

Why do I have to hold my breath after taking my inhaler?

The answer to this may be sort of obvious, but it’s the question that I did not know I had when I read the answer in a Medscape article. Once you inhale the medicine from your inhaler of choice (or circumstance, as the case may be), there are two options for making sure the medicine settles in your lungs:

1) Hold your breath for as long as possible, preferably about ten seconds, OR,
2) Using a spacer, breathe normally in and out 2 to 3 times.

Here’s why: Especially with smaller particle size inhalers, these particles tend to remain airborne, aka “float around”, for awhile after they are inhaled. Either the breath hold (causing the air in the lungs to more or less become still) or slow/normal breathing versus a forceful exhale, allows more of the medicine inhaled to settle on (or “stick to”) the surfaces of the airways, enabling them to NOT be exhaled with your next breath, giving them the chance to work¹.

Why should I shake my inhaler before using it?

Most inhalers contain one or two medicines and a propellant (the “HFA” on your inhaler is the propellant, hydrofluoroalkane, if you’d ever wondered - it replaced CFC or chlorofluorocarbon-propelled inhalers, banned at the end of 2008²).

In general, this is how all aerosols (including inhalers, and spray paint, for instance) work. We can’t just expect a liquid—like the medicine components of inhalers—to evenly disperse itself if we put it in a bottle and try to spray. Propellants are added to inhalers (and other pressurized aerosols) for this purpose, to give them their cloud-like, controlled spray (clouds, by the way, are aerosols technically speaking—tiny liquid particles suspended in air!)³—inhalers take this a step further by the “metered dose” aspect allowing only a specific amount of medicine to be dispensed from the pressurized canister with each spray, Shaking your inhaler a few times before use (recommendations vary from 10 to 20 times, to for 5 to 10 seconds, so just make sure you give it a good go before using it!), ensures the contents of the pressurized canister in your inhaler are well mixed, and you get the intended amount of medicine prescribed—and not more propellant than medicine, for instance⁴.

And there you have it, the Answers to Asthma Questions I Didn’t Know I Had about inhalers—things that I’ve probably subconsciously wondered for nine years and finally came to the surface of my brain (and now, Asthma.Net!)