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Are You Using Your Inhaler Incorrectly?

A fish out of water. Usually this saying refers to feeling out of place in a new situation. But for the one in 13 Americans who have asthma, it has a different meaning.

One way people describe an asthma attack is feeling like a fish trying to breathe on land. When they start feeling shortness of breath, coughing or wheezing, they reach for their inhalers. Most people, however, don’t use them correctly.

2017 review of research showed nearly 87 percent of people studied made at least one mistake in using their metered-dose inhaler. The percentage was somewhat better for those who used dry-powder inhalers, as 61 percent made at least one error. Even more surprising, one study showed that health care professionals were only half as likely as their patients to get it right.

The studies included people with asthma and people with chronic obstructive pulmonary disease (COPD), a progressive condition that causes obstructed airflow from the lungs. COPD is the third leading cause of death in the United States.


In recognition of Respiratory Care Week, Oct. 21-27, consider asking yourself whether you or your child is making any of these common mistakes:

  • Not shaking the inhaler
  • Holding it incorrectly in your mouth
  • Failing to breathe out sufficiently before the puff
  • Incorrectly timing your inhalation with the puff
  • Not breathing in quickly enough or deeply enough with the puff
  • Not holding your breath once the medicine is in your lungs

Why is it important to use the device correctly? As one study’s authors put it, “no matter how good a drug is, it cannot be effective if it does not reach the targeted airways.” Mistakes patients make with inhalers can result in uncontrolled symptoms, such as difficulty breathing, having to use a rescue inhaler more than two days a week and a higher rate of asthma attacks, or flare-ups. Asthma attacks can be fatal.

The American College of Allergy, Asthma & Immunology recommends patients use a valved holding chamber with their inhaler to help direct more of the medicine into the lungs. Some doctors opt for a similar device called a spacer. A holding chamber or spacer doesn’t guarantee you’ll get all the medicine you need; it is still vital to use the right technique.

The CDC recommends these steps for using an inhaler correctly:

  1. Remove the cap
  2. Shake the inhaler 10 to 15 times
  3. Attach the holding chamber or spacer (if you use one)
  4. Take a deep breath and then exhale as much as you can
  5. Put the mouthpiece in your mouth
  6. Close your mouth around it
  7. Squeeze the inhaler to deliver one dose. Breathe in slowly as deeply as you can, and hold for five to 10 seconds
  8. Breathe out slowly

Living with a serious disease like asthma or COPD can be challenging. Take care of yourself or your child by working on proper inhaler technique, and remember to carry an inhaler at all times.