How to Use an Asthma Inhaler: Exhale, Inhale, Hold, Rinse — Are You Doing All Four Steps Right?

Why breathe out before inhaling the medicine?

Many people's first reaction after picking up an inhaler is to press it right away. The problem is this: your lungs still hold leftover air from your last breath, so less medicine can get in this time. The right way is to take off the cap, shake the device, then breathe out as much as you can to make room in your lungs.

When you breathe out, be careful: do not blow into the device. Breathing out into the mouthpiece brings moisture and dust inside and affects the next dose. Breathe out away from the device, then immediately close your lips around the mouthpiece and get ready to breathe in. This step looks simple, but it is the one most often skipped.

If you need two doses at once, usually wait about one minute between them, so the first dose can settle before you repeat the whole routine. Do not press twice in a row — the medicine mostly collides and does not reach where it should go.

How fast and how deep you breathe in decides how deep the medicine reaches

Different devices need different inhalation speeds. With a press-and-breathe metered-dose inhaler used with a spacer, you need to breathe in slowly and deeply, pressing while you breathe in, so the mist follows the airflow. If you breathe in too fast and too hard, the mist tends to hit the back of your throat and stays in your mouth.

Dry powder devices are the opposite: you need to breathe in hard and fast, deeply, because the force of your breath is what carries the powder into the airway. With a dry powder device, if you only breathe in gently, the powder may not come out at all. So when you switch devices, you must learn the technique again — do not carry over old habits.

Another common mistake: pressing and breathing in are not timed together. Your hand presses, your mouth has not started to breathe in, and the medicine has already sprayed into your mouth. Using a spacer can ease this coordination problem — the mist is held in the spacer first, then you breathe it in slowly, which is easier for children and older adults.

Holding your breath for a few seconds is the step most often left out

After breathing in the medicine, do not breathe out right away. Hold your breath for a few seconds so the floating mist has time to settle onto the airway surface. If you breathe out hard right after inhaling, the medicine is carried back out, and the dose is wasted.

You do not need to hold your breath until it feels uncomfortable — a few seconds is usually enough, as long as you feel at ease. After holding, breathe out slowly. If you also use a preventer inhaler, the rinse after use cannot be skipped; the aim is to reduce local discomfort from medicine left in the mouth and throat, such as oral fungal infection.

Rinse all the way to the back of your throat, then spit it out — do not swallow. For young children, a parent should watch them rinse. If you use a spacer, wash and air-dry the body regularly as instructed; do not wipe the inside with a towel, as this can leave static that affects how the medicine comes out.

Ask your doctor to watch you use it at a follow-up visit

It is hard to judge your own inhaler technique. Many people feel they have used it for years and should be fine, but there may be a step they have always missed. It helps to bring your device to each follow-up visit and do the whole routine in front of the doctor, and ask them to point out which step needs to change.

You can also do a simple check at home: when you spray, do you see mist escaping into the air, do you taste medicine clearly in your mouth after inhaling, and do your symptoms improve with use. These are only clues — they cannot replace a doctor's judgment.

If you switch to a new device, change medicine, or someone else in the family starts helping, it is worth learning the technique again. Technique can be changed, and when it is right, the same medicine can work the way it should.

If these things happen, do not increase the dose yourself — see a doctor promptly

If you find you need your reliever medicine more often than usual, or you still feel it is not enough at the instructed dose and use, this suggests your airway narrowing may be getting worse. See a doctor promptly instead of increasing the number of doses yourself.

See a doctor promptly or go to the emergency department if you notice these signs: you can only speak in single words, you get short of breath after walking a few steps, your lips or nails turn blue or purple, chest tightness keeps getting worse, or the reliever medicine does not help. For children, also watch for low energy, refusing to eat, or the skin pulling in between the ribs when breathing.

Also, if white patches keep appearing in your mouth, your throat feels uncomfortable for a long time, or your symptoms are not well controlled after long-term use, raise this at a follow-up visit so the doctor can decide whether the plan needs to change. Any change in medicine should be decided by a doctor.

This article is for general information only and not medical advice. Please follow your doctor's instructions.