Using an inhaler might seem simple-press the canister, breathe in. But if you’re one of the 70 to 90% of people who use it wrong, you might as well be breathing in air. The medication never reaches your lungs. And that’s not just inconvenient-it’s dangerous. For people with asthma or COPD, the difference between correct and incorrect inhaler use can mean the difference between staying out of the hospital and ending up there. Inhaler technique isn’t something you learn once and forget. It’s a skill that needs regular checking, like brushing your teeth or taking blood pressure. Yet most people never get proper instruction. A 2023 study from the National Asthma Council Australia found that 62% of patients over 65 struggled with dry powder inhalers because they couldn’t generate enough force to pull the medication in. Meanwhile, younger users often fumble with metered-dose inhalers because they press the canister too early or too late. There are three main types of inhalers: metered-dose inhalers (MDIs), dry powder inhalers (DPIs), and soft mist inhalers. Each works differently. And each requires a different technique. Mixing them up-or using them all without training-can cut your medication’s effectiveness by half.
How Metered-Dose Inhalers (MDIs) Really Work
MDIs are the most common. You’ve probably seen them: a small plastic tube with a metal canister inside. They deliver medication through a pressurized spray. But here’s the catch: you have to press the canister and breathe in at the exact same time. Most people don’t. They press it first, then try to inhale. Or they breathe in too fast. Either way, most of the medicine hits the back of the throat and gets swallowed-or coughed out. The American Lung Association says the right way is this:- Shake the inhaler well (45% of users skip this)
- Remove the cap and breathe out fully
- Place the mouthpiece in your mouth, sealing your lips around it
- Press the canister as you start to breathe in slowly and deeply-about 3 to 5 seconds
- Hold your breath for 10 seconds after inhaling
- Breathe out slowly
- Wait at least 60 seconds before taking another puff
Dry Powder Inhalers (DPIs): Faster, But Not for Everyone
DPIs don’t use a propellant. Instead, they rely on your own breath to pull the powder into your lungs. Devices like the Diskus, Turbuhaler, and Ellipta are popular because they’re easier to coordinate-no need to press and breathe at once. But here’s the trade-off: you need to inhale hard and fast. At least 60 liters per minute. That’s like taking a deep breath during a sprint. That’s fine if you’re healthy. But if you have severe COPD, your lungs might not be strong enough. A 2021 study in the European Respiratory Journal found that nearly 40% of COPD patients couldn’t generate the flow needed for DPIs. These patients end up with powder stuck in their throat, causing coughing and irritation. One user on Reddit said: “I’ve been using my DPI for three years. I thought it wasn’t working. Turns out I was inhaling like I was sipping tea.” DPI technique is simpler but more physically demanding:- Load the dose (follow device instructions-never open the capsule yourself)
- Breathe out fully, away from the device
- Place mouthpiece in mouth and seal lips
- Inhale quickly and deeply-like you’re trying to smell a flower but with force
- Hold your breath for 10 seconds
- Breathe out slowly
Soft Mist Inhalers: A Middle Ground
The Respimat is the least common but often the most forgiving. It releases a slow-moving mist over 1.5 seconds, giving you time to breathe in naturally. No need for perfect timing. No need for a strong breath. Just inhale slowly and steadily. It’s a good option for older adults, people with weak lung strength, or those who struggle with MDIs and DPIs. But it still requires technique:- Prime the device before first use
- Breathe out gently
- Place mouthpiece in mouth
- Inhale slowly and deeply while pressing the button
- Hold your breath for 10 seconds
Why Technique Matters More Than the Device
You might think the brand of inhaler matters most. But experts say otherwise. 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.” A 2023 review by the Agency for Healthcare Research and Quality found that when used correctly, all inhalers perform similarly. But in real life, where technique is often wrong, effectiveness drops by 30 to 40%. That means you’re paying for a medication that’s not working. And you’re at higher risk for flare-ups, ER visits, and hospital stays. The UK Inhaler Group says technique matters more than device type. Even a cheap MDI with a spacer can outperform a fancy DPI if the DPI is used incorrectly.
Common Mistakes (And How to Fix Them)
Here are the top mistakes patients make-and how to avoid them:- Not shaking the inhaler - 45% of users skip this. Shake it 5 to 10 times before each use.
- Breathing in too fast - Especially with MDIs. Slow, deep breaths work best.
- Exhaling into the device - This can clog DPIs or wet MDIs. Always breathe out away from the inhaler.
- Not holding your breath - 63% of users don’t hold for 10 seconds. That’s the key moment when medication settles in your lungs.
- Using multiple inhalers without training - The European Respiratory Society says technique confusion cuts effectiveness by 35 to 50%. Stick to one or two types, and get trained on both.
What to Do If You’re Still Struggling
If you’ve been using your inhaler for years and still feel like it’s not helping, you’re not alone. A 2023 Drugs.com survey of 3,852 users found that 37% said they didn’t know if they were using it right. And 29% said the medicine “just didn’t work.” Here’s what to do:- Ask your doctor or pharmacist for a technique check. Don’t wait for your next appointment-request it now.
- Watch a video from the American Lung Association or National Asthma Council Australia. They show real-time demonstrations.
- Ask for a spacer if you’re using an MDI. They’re cheap, reusable, and often free with a prescription.
- Consider switching inhaler types. If you’re struggling with a DPI, try an MDI with a spacer. If you can’t coordinate an MDI, ask about Respimat.
- Use a smart inhaler tracker. Devices like Propeller Health attach to your inhaler and log your usage. They even send reminders if you miss a dose or use it wrong.
The Bigger Picture: Why This Isn’t Just About Inhalers
Improper inhaler use isn’t just a personal problem-it’s a public health crisis. The WHO estimates 3.6 million preventable asthma deaths happen each year, mostly in low-income countries where training is scarce. Even in wealthy places like Australia, the US, or the UK, technique errors lead to 22% more ER visits, according to a 2023 JAMA Internal Medicine study. The future is changing. By 2025, 40% of inhalers will have digital sensors that track usage. Some will even adjust dosage based on your breathing. But until then, the best tool you have is knowledge. Your inhaler isn’t magic. It’s a precision tool. And like any tool, it only works if you know how to use it.
What to Do Today
You don’t need to wait for a doctor’s appointment. Start now:- Take out your inhaler. Look at the instructions on the box. Do they match what you’re doing?
- Try the 10-second breath hold. It’s harder than it sounds-but it’s the most important step.
- If you’re using an MDI, get a spacer. Ask your pharmacy for one-they’re usually free.
- Watch one instructional video. The National Asthma Council Australia’s YouTube channel has a 4-minute guide that’s clear and simple.
- Write down your technique steps and practice them in the mirror.
What to Do After a Flare-Up
If you’ve had a recent asthma or COPD flare-up, your inhaler technique should be the first thing your doctor checks. Don’t assume the medication failed. Ask: “Did I use it right?” Many patients think their inhaler is broken. It’s not. It’s working. You just aren’t. And if you’re still unsure? Go back. Ask again. Practice again. Your lungs are worth it.Key Takeaways
- 70-90% of people use their inhaler incorrectly, reducing medication delivery to as low as 8%
- Using a spacer with an MDI increases lung delivery by 70-100%
- DPIs require strong inhalation-unsuitable for many COPD patients
- Always hold your breath for 10 seconds after inhaling
- Rinse your mouth after using steroid inhalers to prevent thrush
- Technique matters more than device type
- Ask your doctor to check your technique at every visit
