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

Most people with asthma or COPD rely on inhalers to breathe easier. But here’s the hard truth: if you’re not using your inhaler correctly, you’re wasting most of your medicine. Studies show 70 to 90% of patients get it wrong. That means instead of 40-60% of the drug reaching your lungs, you’re getting as little as 8-30%. You’re not just missing out on relief-you’re putting yourself at risk for flare-ups, hospital visits, and long-term lung damage.

Why Technique Matters More Than the Device

It’s easy to think the brand or type of inhaler makes the biggest difference. But the truth? Technique beats device every time. A 2023 review by the Agency for Healthcare Research and Quality found that when used properly, all inhalers work equally well. The real gap? How well you use them. Poor technique can cut effectiveness by 30-40%. That’s more than the difference between two different brands.

Dr. Robert Openbush from the American Lung Association says it plainly: “Proper technique is the single most important factor in inhaler effectiveness, more critical than the specific device chosen.” You can have the most advanced inhaler on the market, but if you press the canister too early, don’t hold your breath, or skip the spacer, it’s like buying a sports car and never turning the key.

The Three Main Types of Inhalers-and How Each Works

There are three main types of inhalers, and each needs a different approach. Mixing them up is a common mistake.

• Metered-Dose Inhalers (MDIs) are the most common. Think of them like tiny aerosol cans-press the top, and a puff of medicine shoots out. But you have to time it perfectly: press and breathe in slowly at the same time. If you press too soon or too late, the medicine hits your throat instead of your lungs. ProAir HFA and Ventolin HFA are examples. They work best with a spacer.
• Dry Powder Inhalers (DPIs) like Diskus, Ellipta, and Turbuhaler don’t need a press. You just breathe in fast and hard. The force pulls the powder into your lungs. But if you’re weak from a COPD flare-up, or you breathe too slowly, the powder won’t aerosolize. That’s why many older adults struggle with them. The powder can also get stuck in your throat, causing coughing fits.
• Soft Mist Inhalers like Respimat release a slow, gentle mist over 1.5 seconds. You don’t need to time your breath as precisely, and they don’t require a spacer. But you still need to inhale deeply and hold your breath. They’re a good middle ground for people who can’t coordinate MDIs or can’t generate enough airflow for DPIs.

Here’s the catch: you can’t use a spacer with a DPI. It won’t work. The spacer traps the powder before it can get into your lungs. But with an MDI, a spacer is a game-changer. It increases lung delivery by 70-100%. That’s why the Global Initiative for Asthma (GINA) recommends spacers for everyone using MDIs-even kids.

How to Use an MDI Correctly (Step by Step)

If you’re using a metered-dose inhaler, here’s what you need to do-every single time:

1. Remove the cap and shake the inhaler for 5 seconds.
2. Attach a spacer if you have one (you should).
3. Breathe out fully-away from the device.
4. Place the mouthpiece in your mouth and seal your lips around it.
5. Press the canister to release the puff, then breathe in slowly and deeply over 3-5 seconds.
6. Hold your breath for 10 seconds. This lets the medicine settle into your airways.
7. Breathe out slowly through your nose.

Most people skip step 1 (shaking) or step 6 (holding their breath). The National Asthma Council Australia found 45% of users don’t shake their inhalers. And 63% don’t hold their breath long enough. That’s why the medicine doesn’t work.

Wait 60 seconds between puffs. If your doctor told you to take two puffs, don’t rush. Give your lungs time to absorb the first dose before the second hits.

How to Use a Dry Powder Inhaler Correctly

DPIs are simpler in some ways-no timing needed. But they demand power you might not have.

1. Load the dose as instructed (some twist, some slide, some push).
2. Breathe out fully-away from the device. Never exhale into the inhaler.
3. Put the mouthpiece in your mouth and seal your lips.
4. Breathe in quickly and deeply-like you’re trying to suck a thick milkshake through a straw.
5. Hold your breath for 10 seconds.
6. Breathe out slowly.

Common mistakes? Breathing too slowly (DPIs need 60-90 liters per minute), not loading the dose right, or trying to open the capsule (some users try to tear it open-don’t. It ruins the dose). Also, never use a spacer with a DPI. It cuts effectiveness by 50-70%.

People over 65 often struggle with DPIs because their lung strength drops with age. If you’re older or very weak during a flare-up, talk to your doctor about switching to an MDI with a spacer or a soft mist inhaler.

The Hidden Rules: Mouth Rinsing, Storage, and More

There are little things that make a big difference-and most people ignore them.

• Rinse your mouth after using corticosteroid inhalers. If you don’t, you’re at high risk for oral thrush-a fungal infection that causes white patches and soreness. A 2022 study in Chest showed rinsing cuts this risk by 75%.
• Store your inhaler at room temperature. Heat kills the medicine. If you leave it in a hot car or on a sunny windowsill, effectiveness drops 15-20%. Keep it at 20-25°C.
• Never use expired inhalers. Even if it still makes a sound, the dose may be off. Most last 12 months after opening.
• Don’t mix devices without training. Using two different inhalers without knowing the right technique for each can reduce effectiveness by 35-50%. Stick to one type unless your doctor says otherwise.

What Real Patients Say-and What They Wish They Knew

People aren’t lying when they say they’re using their inhalers right. They just don’t know they’re doing it wrong.

On Reddit, 68% of users said they had trouble coordinating the press-and-breathe motion with MDIs. Many didn’t realize they were puffing before inhaling until they watched a video. One user wrote: “I’ve been using my inhaler wrong for 10 years. I thought the puff was the medicine. Turns out, the breath is.”

Drugs.com reviews show 37% of users say, “I don’t know if I’m using it correctly.” That’s the biggest complaint. And 29% say, “The medicine doesn’t work.” Often, it’s not the drug-it’s the delivery.

But here’s the good news: when people add a spacer to their MDI, 78% report better symptom control. That’s a huge jump. And when they learn the 10-second breath hold, many say their flare-ups drop from weekly to monthly.

What Your Doctor Should Be Checking (But Probably Isn’t)

The American Lung Association and the National Asthma Education and Prevention Program say: assess inhaler technique at every visit. That’s not optional. It’s standard care.

Yet, in many clinics, doctors hand you the inhaler, say “use as directed,” and move on. That’s not enough. A 2023 study in JAMA Internal Medicine found that when providers checked technique at every appointment, emergency visits dropped by 22%.

Ask your doctor or pharmacist to watch you use your inhaler. Do it in front of them. No shame. Most have a mirror or a training device. If they don’t offer, ask: “Can you watch me use it? I want to make sure I’m getting the full benefit.”

Some clinics now use video tutorials on tablets. Others have inhaler trainers-plastic devices that light up when you breathe right. If yours doesn’t, ask for one.

The Future: Smart Inhalers and Better Tools

Technology is catching up. In 2021, the FDA approved the first smart inhaler sensor-Propeller Health. It attaches to your inhaler and tracks when you use it, how hard you inhale, and even if you used it correctly. In a 2022 study, it was 92% accurate.

By 2025, 40% of inhalers are expected to have digital tracking. That means your doctor will know if you’re skipping doses or using the wrong technique. And soon, inhalers will adjust doses based on your breathing patterns-expected by 2026-2027.

But here’s the reality: even the smartest inhaler won’t help if you don’t learn the basics. Digital tools are helpful, but they’re not magic. Technique still comes first.

What to Do Next

You don’t need to be perfect. You just need to be better than you are now.

• Watch a 3-minute video from the American Lung Association or Global Initiative for Asthma (GINA). Don’t just watch-do it with your inhaler in hand.
• Ask your pharmacist to check your technique. They’re trained to do it.
• Get a spacer if you use an MDI. They cost less than $15 and are often covered by insurance.
• Rinse your mouth after every corticosteroid inhaler use.
• Write down your inhaler type and the steps. Stick it on your bathroom mirror.

Improving your technique isn’t about following rules. It’s about reclaiming your breathing. Every time you use your inhaler right, you’re not just taking medicine-you’re protecting your lungs for years to come.