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

Did you know that if you’re using your inhaler wrong, up to 90% of your medication never reaches your lungs? It’s not the drug that’s failing you-it’s the technique. For people with asthma or COPD, inhalers are the lifeline. But without the right method, even the most advanced device is just a fancy canister. Millions use them daily, yet most don’t know how to use them properly. And that’s not just inconvenient-it’s dangerous.

Why Technique Matters More Than the Device

There are dozens of inhalers on the market: metered-dose inhalers (MDIs), dry powder inhalers (DPIs), and soft mist inhalers like Respimat. Each looks different, works differently, and requires a different approach. But here’s the truth: how you use it matters more than which one you have.

A 2022 study in the Journal of Asthma found that 70 to 90% of people use their inhalers incorrectly. That means if you’re taking two puffs a day, you might only be getting the equivalent of one puff-or less. The difference between proper technique and poor technique? It’s not 10% better. It’s 40 to 60% more medication reaching your lungs. That’s the difference between feeling in control and ending up in the emergency room.

The American Lung Association says technique is the #1 factor in effectiveness-not the brand, not the price, not even the type of medicine. Dr. Robert Openbush from the American Lung Association puts it bluntly: “Proper technique is the single most important factor in inhaler effectiveness, more critical than the specific device chosen.”

Three Main Types of Inhalers-and How to Use Each

Not all inhalers are created equal. Knowing which one you have-and how to use it-is non-negotiable.

Metered-Dose Inhalers (MDIs)

These are the classic aerosol inhalers: a metal canister in a plastic holder. Examples include ProAir HFA, Ventolin HFA, and Flovent HFA. They use a propellant to push the medicine out in a puff.

Correct technique for MDIs:

1. Shake the inhaler well for 5 seconds.
2. Remove the cap and check for obstructions.
3. Breathe out fully-away from the inhaler.
4. Place the mouthpiece between your lips, sealing them tightly.
5. Start breathing in slowly and deeply through your mouth, and at the same time, press down on the canister.
6. Keep breathing in slowly for 3 to 5 seconds.
7. Hold your breath for 10 seconds (yes, count to 10).
8. Breathe out slowly through your nose.

If you’re using an MDI without a spacer, you’re likely wasting most of your dose. Studies show that only 8 to 30% of the medicine gets into your lungs this way. Add a spacer-a plastic tube that holds the puff until you breathe it in-and that jumps to 40 to 60%. For kids, older adults, or anyone struggling with coordination, a spacer isn’t optional. It’s essential.

Dry Powder Inhalers (DPIs)

These include Diskus, Turbuhaler, Ellipta, and Genuair. No propellant. No timing needed. But you need a strong, fast breath.

Correct technique for DPIs:

1. Load the dose as instructed (some require twisting, others clicking).
2. Breathe out fully-away from the device.
3. Place mouthpiece in your mouth and seal your lips.
4. Inhale quickly and deeply-like you’re trying to suck through a straw.
5. Hold your breath for 10 seconds.
6. Breathe out slowly.

Here’s the catch: DPIs require a minimum inspiratory flow of 30 to 60 liters per minute. If you’re elderly or have severe COPD, you might not generate enough force. That’s why 62% of people over 65 struggle with DPIs, according to the National Asthma Council Australia. If you’re coughing after using a DPI, or the powder sticks in your throat, you’re not inhaling hard enough. And no, you can’t use a spacer with a DPI-it’ll block the powder and ruin the dose.

Soft Mist Inhalers (SMIs)

The Respimat is the only widely used soft mist inhaler. It releases a slow, fine mist over 1.5 seconds. Less coordination needed than MDIs, less effort than DPIs.

Correct technique for Respimat:

1. Press the green button to load the dose.
2. Breathe out fully-away from the device.
3. Place mouthpiece in your mouth and close lips.
4. Inhale slowly and deeply through your mouth.
5. Hold your breath for 10 seconds.
6. Breathe out slowly.

SMIs are great for people who can’t coordinate an MDI or can’t generate enough force for a DPI. But they’re not magic. If you breathe too fast or too shallow, you’ll still miss the dose.

The #1 Mistake Everyone Makes

It’s not shaking the inhaler. It’s not forgetting to rinse your mouth. It’s not even skipping the spacer.

It’s not holding your breath.

The National Heart, Lung, and Blood Institute says holding your breath for 10 seconds after inhaling increases lung deposition by 20 to 30%. That’s huge. But most people exhale immediately. Why? Because it feels unnatural. Because they’re not taught. Because they don’t know it matters.

A YouTube analysis of 500 comments on inhaler tutorials found that “I’ve been using my inhaler wrong for 10 years” was the most common refrain. People weren’t being careless-they were just never shown how.

What Happens When You Use It Wrong

If your technique is off, here’s what you’re dealing with:

• More frequent flare-ups
• More emergency room visits
• Higher doses needed to feel relief
• More side effects from swallowed medicine (like oral thrush or hoarseness)
• Doctors thinking your medication isn’t working-so they add more drugs, or switch you to stronger ones

A 2023 study in JAMA Internal Medicine found that patients whose inhaler technique was checked and corrected at every doctor visit had 22% fewer emergency visits. That’s not a small win. That’s life-changing.

Common Mistakes (and How to Fix Them)

Here’s what most people do wrong-and how to stop it:

• Not shaking the MDI → Shake for 5 seconds before every puff. Even if you used it 10 minutes ago.
• Exhaling into the device → Always breathe out away from the inhaler. Moisture can clog DPIs and ruin MDI valves.
• Pressing the canister too early or too late → With MDIs, press and inhale at the same time. Practice with just water (no medicine) until it feels natural.
• Using a spacer with a DPI → Never do this. It cuts delivery by 50 to 70%. Spacers are only for MDIs.
• Forgetting to rinse your mouth → After using corticosteroid inhalers (like Flovent or Pulmicort), rinse and spit. Reduces oral thrush risk by 75%.
• Trying to open DPI capsules → Never remove the capsule from the device. It’s designed to be inhaled as-is.
• Storing inhalers in hot places → Keep them at room temperature (20-25°C). Heat above 30°C can reduce potency by 15-20%.

When to Use a Spacer-and When Not To

Spacers are plastic tubes that attach to MDIs. They’re simple. They’re cheap. And they’re one of the most underused tools in asthma and COPD care.

Use a spacer if you:

• Have trouble coordinating the puff and breath
• Are over 65
• Are a child
• Use a corticosteroid inhaler
• Feel the medicine hitting your throat

Spacers don’t just help-they’re game-changers. They let the medicine settle in the chamber while you breathe in slowly. No timing needed. No rushing. And you get 70 to 100% more medicine into your lungs.

Never use a spacer with:

• Dry powder inhalers (DPIs)
• Soft mist inhalers (like Respimat)

Using a spacer with a DPI is like trying to drink soup through a straw with a lid on-it won’t work. And you’ll waste your medication.

What Your Doctor Should Be Checking

You shouldn’t have to figure this out alone. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) and the National Asthma Education and Prevention Program both say: assess inhaler technique at every visit.

But most doctors don’t. A 2023 survey found that only 45% of patients in the U.S. had their technique checked in the past year. In countries with national training programs-like the UK’s Inhaler Champions initiative-proper technique rates hit 75%. In places without, it’s 45% or lower.

Ask your doctor: “Can you watch me use my inhaler right now?” Don’t wait for them to ask. Bring your inhaler to every appointment. Show them how you use it. If they don’t watch, ask for a nurse or respiratory therapist who can.

What’s Changing Now-and What’s Coming

Technology is stepping in. Smart inhalers with sensors (like Propeller Health) track when you use your device and whether your inhalation was strong enough. FDA-approved since 2021, they’ve been shown to improve technique accuracy by 92% in clinical studies.

By 2025, experts predict 40% of inhalers will include digital monitoring. That means your inhaler might text you: “You didn’t hold your breath. Try again.”

Even more exciting? Breath-actuated MDIs are in late-stage trials. These devices automatically release the puff when you inhale-no pressing needed. For people with shaky hands or poor coordination, this could be revolutionary.

But here’s the hard truth: none of that matters if you don’t learn the basics first. No app fixes bad technique. No smart device replaces knowing how to breathe right.

Final Checklist: Are You Using Your Inhaler Right?

Go through this before your next dose:

• Do I know what type of inhaler I have? (MDI, DPI, or SMI?)
• Did I shake my MDI for 5 seconds?
• Did I breathe out fully before inhaling?
• Did I inhale slowly and deeply?
• Did I press the canister at the same time as I inhaled (MDI only)?
• Did I hold my breath for 10 seconds?
• Did I rinse my mouth after using steroids?
• Did I wait 60 seconds between puffs?
• Is my inhaler stored at room temperature?

If you answered “no” to any of these, you’re not getting the full benefit. That’s not your fault. It’s a system failure. But you can fix it today.

Grab your inhaler. Go to a quiet place. Watch a 2-minute video from the American Lung Association or the National Asthma Council Australia. Practice in front of a mirror. Do it until it feels automatic. Your lungs will thank you.

Next Steps: What to Do Today

1. Find your inhaler. Look at the label. Know what type it is. 2. Watch a 2-minute video from the American Lung Association or National Asthma Council Australia. 3. Practice the technique in front of a mirror. 4. Ask your doctor or pharmacist to watch you use it at your next visit. 5. If you’re using an MDI and don’t have a spacer, ask for one. They’re often free or low-cost. 6. Rinse your mouth after every corticosteroid inhaler use. Your inhaler is your lifeline. Don’t let poor technique cut its power in half. Learn how to use it right-and breathe easier, not harder.