How to Use Your Inhaler

According to the CDC, as of July 2023, almost 25 million Americans have asthma. Inhaled medications will likely be used at some point as part of their therapy. Asthma medications come in many delivery devices, including metered-dose inhalers (MDIs, also called HFAs [hydrofluoroalkane], a type of propellant), Diskus inhalers, Flexhaler dry powder inhalers, Respimat inhalers, Twisthalers, Ellipta dry powder inhalers, RediHaler aerosol inhalers, Inhub inhalers, and dry powder inhalers. In addition, devices called valved holding chambers/spacers can also assist with using the delivery systems more effectively. 

There are several reasons to use a spacer with MDIs; without a spacer, the medication dispensed can stop at the back of the throat and not actually get into the lungs where it’s needed. Spacers allow patients to use the medication more efficiently during a symptomatic period. In addition, spacers help get the medication into the lungs, enabling patients to receive the full dose, even if they cannot coordinate dispensing the medication and breathing it in well. 

This handout describes use of MDIs/HFAs, Diskus inhalers, and Ellipta dry powder inhalers, as these are the most common. 

Metered-Dose Inhalers/HFAs

These medications include albuterol sulfate, levalbuterol tartrate, ipratropium bromide, mometasone furoate, fluticasone propionate, fluticasone propionate/salmeterol xinafoate, mometasone furoate/formoterol fumarate dihydrate, beclomethasone dipropionate, and budesonide/formoterol fumarate dihydrate. 

1. Shake the inhaler for 10 seconds with the base/mouthpiece resting on the thumb and the medication container resting underneath the index and/or long fingers. 
2. Remove the cap from the base of the inhaler. If using a spacer, put the mouthpiece of the inhaler into the spacer device. 
3. Take a breath in and then breathe out.
4. After breathing out fully, place the inhaler (or chamber) in the mouth and seal the mouth around the base. 
5. While squeezing the thumb and index/long fingers together to dispense one “puff” of medication, breathe in slowly, deeply, and steadily.
6. Remove the inhaler from the mouth and then hold your breath for 10 seconds before breathing out slowly. 
7. Repeat for as many puffs as are prescribed and rinse your mouth out when done (especially if the medication contains a steroid). 
8. Return the cover to the mouthpiece until the next use. 

1. Open the device by keeping it flat and using your thumb to slide the cover open until it clicks and locks in position. 
2. Use your thumb again to slide the dose lever away from the mouthpiece until it clicks. 
3. Take a breath in and then breathe out. 
   
4. After breathing out fully, place the inhaler in the mouth and seal the mouth around the mouthpiece. 
5. Breathe in quickly and fully. 
6. Remove the inhaler from the mouth and then hold your breath for 10 seconds before breathing out slowly. 
7. Repeat for as many puffs as are prescribed and rinse your mouth out when done (especially if the medication contains a steroid). 
8. Slide the cover back in place until the next use. 

Ellipta Inhalers

These include fluticasone furoate, fluticasone/vilanterol, fluticasone/vilanterol/umeclidinium, umeclidinium, and umeclidinium/vilanterol. 

1. Slide the cover of the device until it clicks and loads a dose of medication.
2. Take a breath in and then breathe out. 
3. After breathing out fully, place the inhaler in the mouth and seal the mouth around the mouthpiece. 
   
4. Breathe in quickly and fully. 
   
5. Remove the inhaler from the mouth and then hold your breath for 5 seconds before breathing out slowly.
   
6. Repeat for as many doses as are prescribed and rinse your mouth out when done (especially if the medication contains a steroid). 
   
7. Slide the cover back over the mouthpiece to close until the next use. 

If you have any questions about how to properly use your medications, you can always reach out to your osteopathic family physician, their office staff (nurse or medical office assistant, for example), or your pharmacist to walk you through proper use. For updated videos on how to use these or other inhaler types, visit the American Lung Association website. 

Sources

American Lung Association. How to use a metered-dose inhaler without a valved holding chamber or spacer. https://www.lung.org/getmedia/1aa45911-f79f-44ef-a348-08e089e1a57c/MDI-one-pager.pdf?ext=.pdf  

American Lung Association. How to use a metered-dose inhaler with a valved holding chamber (spacer). https://www.lung.org/getmedia/7b211791-b4a6-4cda-890e-b5e05ab9c38f/MDI-w-Spacer-one-pager.pdf?ext=.pdf   

American Lung Association How to use a metered-dose inhaler with a valved holding chamber (spacer) and mask. https://www.lung.org/getmedia/ee743a2e-11f5-48ac-a763-be68a0dd25ec/MDI-w-Spacer-and-Mask.pdf?ext=.pdf  

American Lung Association. How to use a Diskus dry powder inhaler.  https://www.lung.org/getmedia/bf1a80ce-544d-47d8-b919-753b01efb6d2/diskus.pdf?ext=.pdf  

American Lung Association. How to use an Ellipta dry powder inhaler.  https://www.lung.org/getmedia/331d5331-83f5-4230-8fa9-600e9205e692/Ellipta-one-pager.pdf?ext=.pdf   

U.S. Centers for Disease Control and Prevention (CDC). Asthma surveillance data. https://www.cdc.gov/asthma-data/about/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fasthma%2Fasthmadata.htm