Inhaler Technique: 8 Essential Steps for Proper Medication Delivery

Most people who use an inhaler think they’re doing it right. But if you’re only getting 10-20% of your medication into your lungs, you’re not. You’re just spraying medicine into your mouth and throat. That’s not just ineffective-it’s dangerous. Up to 90% of people using metered-dose inhalers (MDIs) for asthma or COPD make at least one critical mistake. And that mistake is costing lives, increasing hospital visits, and wasting billions in healthcare costs every year.

Why Your Inhaler Isn’t Working

Your inhaler doesn’t fail. You do. The device works perfectly if used correctly. But most people press the canister and breathe in at the same time-or worse, they breathe in too fast, too late, or not at all. The result? 80% of the dose lands in your mouth or throat. That’s why you get a sore throat, hoarse voice, or even oral thrush from steroid inhalers. That’s also why your symptoms don’t improve, even though you’re taking your medicine every day.

MDIs deliver medicine in tiny particles-50 to 150 microns wide. These particles need to travel deep into your airways to work. But they’re heavy. If you breathe in too hard or too fast, they crash into the back of your throat and stick there. If you breathe in too slowly, they don’t go deep enough. And if you don’t time the spray right, they just float around your mouth. The sweet spot? Start breathing in slowly just before you press the inhaler, then keep breathing in for 3 to 5 seconds. Then hold your breath for 10 seconds. That’s it. But 63% of people don’t hold their breath long enough. And 68% press the inhaler too late in the breath cycle.

Step-by-Step: How to Use a Metered-Dose Inhaler Correctly

Here’s the exact sequence that works-no guesswork, no shortcuts. Do this every time, even if you’ve been using your inhaler for years.

1. Remove the cap and check the mouthpiece for any blockages. If you see powder or debris, wipe it gently with a dry cloth. Don’t rinse it with water-this can damage the device.
2. Shake the inhaler for 5 to 10 seconds. This mixes the medicine and propellant. Skip this step and you might get half a dose-or none at all. Exception: Alvesco and QVAR don’t need shaking. Check your label.
3. Breathe out fully-as far as you can. Empty your lungs completely. Don’t just exhale a little. This creates space for the medicine to go deep.
4. Place the mouthpiece between your teeth and seal your lips tightly around it. No gaps. No holding it 1 inch away from your mouth. That’s an old trick from CFC inhalers. HFA inhalers require a closed-mouth seal.
5. Start breathing in slowly through your mouth-just before you press the inhaler. Aim for a steady, deep breath that lasts 3 to 5 seconds. Think of it like sipping a thick milkshake through a straw. Not a gasp. Not a cough. A slow, controlled pull.
6. Press the inhaler once while continuing to inhale. Don’t press and then wait. Don’t press and then breathe in. Do both together. The timing is critical. One second late means most of the dose is lost.
7. Hold your breath for 10 seconds. Count slowly: “one-Mississippi, two-Mississippi…” This lets the medicine settle into your airways. If you exhale too soon, the particles bounce back out. Holding your breath increases lung delivery by 30%.
8. Breathe out slowly through your nose. Then rinse your mouth with water and spit it out. Especially if you’re using a steroid inhaler. This cuts your risk of thrush by 40%.

What Happens When You Get It Wrong

Let’s say you forget to shake your inhaler. You press it, breathe in, and feel nothing. You think it’s empty. So you press it again. And again. Now you’ve taken three doses instead of one. Your heart races. Your hands shake. That’s because you just flooded your bloodstream with albuterol. That’s not an emergency-it’s a side effect of bad technique.

Or you breathe in too fast. The medicine hits your throat and sticks. You get a scratchy throat. You stop using your inhaler because it “makes you feel weird.” But you’re not using it wrong-you’re using it incorrectly. The medicine isn’t broken. Your technique is.

And then there’s the spacer myth. Some people think spacers are only for kids. That’s not true. Spacers increase lung delivery from 10-20% to 70-80%. They eliminate the need for perfect timing. They’re especially helpful if you have arthritis, shaky hands, or weak lungs. A 2022 study found that people using spacers had 45% fewer asthma attacks than those who didn’t.

When to Use a Spacer

A spacer is a tube that attaches to your inhaler. It holds the medicine in a chamber so you can breathe it in slowly, without needing perfect timing. You press the inhaler once. Then you breathe in slowly through the mouthpiece. It’s that simple.

Spacers are recommended for:

• Children under 12
• Older adults with limited hand strength or coordination
• Anyone using steroid inhalers (like Flovent or Advair)
• People who feel the medicine hit their throat
• Anyone who’s had a hospital visit for uncontrolled asthma

Most spacers come with a mask for young children. For adults, the mouthpiece version works best. Clean it once a week with soapy water. Don’t dry it with a towel-air-dry it. A dirty spacer can trap mold and bacteria.

What About Dry Powder Inhalers?

If you’re using a dry powder inhaler (DPI) like Advair Diskus or Symbicort Turbuhaler, the rules are different. You don’t shake it. You don’t use a spacer. You breathe in hard and fast-60 liters per minute. That’s like taking a quick, deep sniff of a strong perfume.

But if your lungs are weak-because of COPD, age, or a recent flare-up-you might not be able to inhale that fast. That’s why DPIs fail for many people. If you struggle to take a deep, forceful breath, an MDI with a spacer is safer. Your doctor can test your inspiratory flow rate. If it’s below 30 liters per minute, stick with an MDI and spacer.

Smart Inhalers and New Tech

There’s new tech out there. Smart inhalers with built-in sensors track when you use your inhaler-and whether you used it right. Propeller Health and ResMed have devices that connect to your phone and give real-time feedback. They tell you if you breathed too fast, didn’t hold your breath, or forgot to prime the inhaler.

These aren’t gimmicks. A 2022 study found they detect technique errors with 92% accuracy. And they work. Patients using them had 30% fewer symptoms and used fewer rescue inhalers. The catch? They cost more. But if you’ve been to the ER twice this year for asthma, it might be worth it.

By 2025, every prescription inhaler in the U.S. will come with a QR code that links to a short video showing the correct technique. That’s a big step forward. But videos don’t replace hands-on training. You need to practice in front of someone who can watch you and correct you.

How to Get It Right-For Good

You can’t learn this from a pamphlet. You can’t learn it from YouTube. You learn it by doing it-with someone watching.

Ask your doctor or pharmacist to watch you use your inhaler during your next visit. Bring your device. Do it exactly how you do it at home. They’ll spot the error you didn’t know you were making. Maybe you’re not shaking it. Maybe you’re breathing in too fast. Maybe you’re holding your breath for only 3 seconds.

Practice with a placebo inhaler. Many clinics have them. They look and feel like the real thing but don’t contain medicine. Use it at home every day for a week. Build the muscle memory. Then test yourself in front of a mirror. Can you see your lips sealed? Are you breathing in slowly? Are you holding your breath long enough?

And if you’re a parent: teach your child. Don’t assume they’re doing it right. Watch them. Ask them to show you. If they’re coughing after using their inhaler, they’re not getting the medicine where it needs to go.

Final Check: Are You Doing It Right?

Here’s a quick self-test. If you answer yes to any of these, your technique needs work:

• Do you feel the medicine in your throat?
• Do you get a sore throat or white patches in your mouth?
• Do you use your rescue inhaler more than twice a week?
• Do you feel your symptoms aren’t improving, even with daily use?
• Do you forget to shake the inhaler or prime it when new?

If you said yes to even one, you’re not getting the full benefit. That’s not your fault. It’s because no one ever showed you the right way.

Correct technique isn’t complicated. It’s just precise. And it’s the difference between managing your condition-and being controlled by it.

Next Steps: What to Do Today

Don’t wait for your next appointment. Take action now.

• Grab your inhaler. Look at the label. Does it say to shake it? Does it say to prime it? Write down the instructions.
• Go to the mirror. Practice the 8 steps slowly. Do it five times.
• If you use a steroid inhaler, rinse your mouth after every use-even if you think you’re fine.
• Call your pharmacy. Ask if they have a placebo inhaler you can practice with.
• Next time you see your doctor, say: ‘Can you watch me use my inhaler?’ Don’t be shy. This is one of the most important things you can do for your health.

Proper inhaler technique isn’t optional. It’s the foundation of your treatment. Get it right, and your lungs will thank you-for years to come.