When you are prescribed a new medication you are told how to use it. This is easy if it’s a pill or liquid. If you can count and measure you’ll be ok. Problem with inhalers is the instructions leave a lot to your interpretation. 2 puffs 4 times a day. 2 breaths daily. What does that really mean? You’ve been told HOW OFTEN to use the medication but you weren’t instructed on HOW to use it.

You open the box with the medication and you’ve got this device in your hands that, depending on the medication, can look like something from Star Trek. It can be a metal canister in a plastic sleeve. It can be a round disk with a lever on it. What do you do? You start by reading the instructions that came in the box. OK. Now you’re still confused. It leaves a lot to interpretation.

If you were lucky the doctor may have had his nurse show you how to use it. The pharmacist may have given you verbal instructions. You may have been in the hospital and a nurse or respiratory therapist instructed you. These scenarios are not the norm. You’re usually given a prescription, go to the pharmacy and get it filled, go home and become confused. Now, you may read the instructions and feel you understand them and use the medications. You may have gotten some benefits from them but how do you really know you’re using them correctly? You don’t.

When I was in homecare and was in a patient’s house I’d look for signs that they used an inhaler or I’d come right out and ask. I’d then ask them to show me how they use it. The majority had the right idea but they were not using them to get maximum benefits. If you’re not getting the maximum benefits you’re not managing your disease/condition correctly. You may be going to the emergency room more often or using your medication more often with less relief.

Some of my patients interpreted 2 puffs to mean they depress or squeeze the canister twice while they took one breath. Or they took two breaths, one right after the other and depressed the canister each time. Some took a deep breath before depressing the canister and others depressed the canister before they took a breath. Using an inhaler correctly may take some practice. You need to coordinate your breathing and depression of the canister just right. You are essentially drawing the medication into your lungs.

Correct Use
• Sit up straight or stand
• Take the cover off the mouthpiece
• Shake the inhaler 3-4 times
• Exhale fully, away from the canister
• Open your mouth and put the canister about 2 fingers away from your lips
• Slowly start to inhale, depress the canister once as you're inhaling and keep inhaling
• Close your mouth and hold your breath for 10 seconds. If you can’t hold your breath that long, hold it as long as you can
• Slowly exhale
• If you are to take more than 1 puff, wait about 1 minute and repeat.

Alternate Methods
You can put the mouthpiece directly into your mouth and close your lips around it but you need to be careful not to block the opening with your teeth or tongue. This is not the preferred method because a lot of the medication will stay on your tongue or in the back of your throat, not going to your airways and lungs where you need it.

Note:   If you are using a dry powder inhaler, close your mouth tightly around the mouthpiece and breathe in very fast.

If you are using an inhaled steriod you MUST rinse your mouth after use.

Your doctor may have prescribed a spacer to use with the inhaler. This is great. It slows the delivery of the medication down allowing more medication to go where it needs to.

Now that you know the correct technique to using an inhaler it will help to understand WHY the proper technique is important.

• Standing or sitting up straight uses gravity to help the medication go down, it also allows you to take a deeper breath
• Exhaling fully will allow you to take a deep breath, bringing more of the medication into your lungs
• Breathing slowly, inhaling before depressing the canister and continuing to inhale after depressing the canister starts the flow of air into your lungs, enabling you to draw more of the medication into the airways and lungs
• Holding you breath for 10 seconds will allow the medication to reach farther down in your lungs and airways. If you don’t hold your breath you are exhaling the medication and it’s not going where it needs to
• Waiting 1 minute between breaths allows the medication to start to work, opening up the airways, the next breath will be deeper and allow the medication to go farther down into the airways and lungs
• Rinsing your mouth after using an inhaled steroid helps prevent a sore throat or mouth infection. You must rinse and spit, do not swallow.

You may need to practice in front of a mirror a few times to get it right but I have faith and know you will become a master in no time.

Once you start using the inhaler correctly you may notice that you’re not feeling the need for the medication between doses and spending less time in your doctor’s office or the emergency room.