Inhaler Technique: Step-by-Step Guide for Accurate Medication Delivery

Most people with asthma or COPD use an inhaler every day. But here’s the hard truth: inhaler technique is wrong in 70 to 90% of cases. That means if you’re using your inhaler the way you’ve always done it, you’re probably getting less than 20% of your medication into your lungs. The rest is stuck in your mouth or throat - not helping your breathing, but causing side effects like thrush, hoarseness, or even worsening symptoms.

Why Your Inhaler Isn’t Working Like It Should

Metered-dose inhalers (MDIs) are tiny, pressurized cans that spray medicine into your airways. They’ve been around since the 1950s, but most people still use them wrong. The medicine comes out in a fast puff - about 0.1 to 0.2 seconds - and if you don’t time your breath right, it hits the back of your throat instead of your lungs. That’s why so many people say, "I used my inhaler, but I still feel wheezy." The problem isn’t the medicine. It’s the delivery. Studies show that when technique is correct, up to 80% of the dose reaches the lungs. When it’s wrong? Only 10 to 20%. That’s why your doctor keeps asking you to refill your rescue inhaler every month - not because your asthma is getting worse, but because you’re not getting the full dose.

The 8-Step Correct Inhaler Technique

Here’s how to use your inhaler properly - every single time. This applies to standard HFA inhalers like Ventolin HFA, Flovent HFA, Advair HFA, and Symbicort. (Note: Some newer inhalers like QVAR and Alvesco don’t need shaking - check your label.)

1. Remove the cap. Check for dust or debris inside the mouthpiece. Don’t rinse the mouthpiece with water - it can damage the device.
2. Shake the inhaler for 5 to 10 seconds. Most HFA inhalers need this. Shaking less than 5 seconds can reduce the dose by 25 to 40%. If your inhaler hasn’t been used in two weeks, prime it with 2 to 4 test sprays into the air (check your prescription label - Alvesco needs 2, QVAR needs 4).
3. Breathe out fully. Empty your lungs completely. Don’t breathe out into the inhaler. Just let all the air go.
4. Place the mouthpiece between your teeth and seal your lips around it. No gaps. No holding it 1 inch away. This is a common mistake. The spray needs to go directly into your mouth.
5. Start breathing in slowly and deeply just before or at the same time as pressing down. This is the hardest part. Press the inhaler and breathe in - not before, not after. If you press first and then breathe, you’ll get a puff of medicine in your mouth. If you breathe in first, you’ll inhale nothing. The goal is to match the puff with the start of your inhale.
6. Keep breathing in slowly for 3 to 5 seconds. Don’t take a quick, sharp breath. You need to inhale at about 30 liters per minute. Too fast, and the medicine hits your throat. Too slow, and it doesn’t reach deep enough.
7. Hold your breath for 10 seconds. This lets the medicine settle in your airways. Studies show holding for 10 seconds increases lung deposition by 30% compared to just 5 seconds. Count slowly: "one-Mississippi, two-Mississippi..."
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 like Flovent or Advair. This cuts your risk of oral thrush by 40%.

What Most People Get Wrong

You’re not alone if you’ve made these mistakes. Here are the top five errors, based on clinical data:

• Not exhaling fully before inhaling. 42% of users skip this. If your lungs are already full, you can’t pull in the medicine properly.
• Holding your breath for less than 5 seconds. 63% of patients do this. The medicine needs time to stick to your airway walls.
• Inhaling too fast. 57% of users take a sharp, quick breath. That sends the medicine straight to your throat.
• Forgetting to prime the inhaler. 31% of people don’t prime a new or unused inhaler. That means the first few puffs are just propellant - no medicine.
• Head tilted too far back or forward. 28% of users tilt their head incorrectly. Keep your head level, eyes straight ahead. It helps the medicine flow down into your lungs.

Spacers: The Secret Weapon for Better Delivery

If you struggle with timing - especially if you’re older, have arthritis, or are helping a child - a spacer (also called a holding chamber) is a game-changer. It’s a plastic tube that attaches to your inhaler. You spray the medicine into the spacer, then breathe in slowly from it.

• Spacers boost lung delivery from 10-20% to 70-80%.
• You don’t need perfect timing - spray once, then breathe in normally.
• They reduce throat irritation and thrush by trapping large particles before they reach your mouth.
• For kids, use a spacer with a mask. It’s easier than trying to get them to seal their lips around a mouthpiece.

A 2022 study found that people using spacers had 45% fewer asthma attacks than those using inhalers alone. And it’s not expensive - most are under £10 in the UK, and many pharmacies give them out for free with a prescription.

Dry Powder vs. Metered-Dose: Which Is Right for You?

Not all inhalers are the same. There are two main types:

Comparison of Inhaler Types

Feature	Metered-Dose Inhaler (MDI)	Dry Powder Inhaler (DPI)
Medication delivery	Press and breathe slowly	Breathe in fast and deep
Inhalation speed needed	30 liters per minute	60 liters per minute
Best for	Most adults, children, emergency use	People who can take a strong, fast breath
Requires shaking?	Yes (except QVAR, Alvesco)	No
Needs spacer?	Yes, for better results	No
Onset of action	1-5 minutes	5-15 minutes
Moisture sensitive?	No	Yes - keep dry

If you can’t take a fast, deep breath - maybe because of COPD, age, or weakness - a DPI won’t work for you. MDIs with spacers are the better choice. If you’re young and healthy, and you can inhale hard and fast, a DPI might be easier. But if you’re unsure, stick with the MDI + spacer combo. It’s the most forgiving and effective for most people.

What to Do If You’re Still Struggling

Even after reading this, if you’re not sure you’re doing it right, here’s what to do next:

• Ask your pharmacist to watch you use your inhaler. They see dozens of patients every day. They’ll spot your mistake in seconds.
• Use a placebo inhaler for practice. Your doctor can give you a non-medicated version. Practice the steps until it’s automatic.
• Download a training app. Apps like Propeller Health use sensors to detect your technique and give real-time feedback. They’re 92% accurate.
• Watch a video. The NHS and Asthma UK have short, clear videos on YouTube. Watch one with your inhaler in hand.
• Ask for a spacer. If you haven’t used one, try it. It’s the single easiest upgrade to your treatment.

Don’t wait until you’re in the emergency room because your inhaler "didn’t work." Most of the time, it did - you just didn’t get the dose where it needed to go.

What’s Changing in 2025

By 2025, every prescription inhaler in the UK and US will have a QR code on the box. Scan it with your phone, and you’ll get a short video showing the correct technique for that exact device. That’s because research shows people remember better when they see it done.

Some new inhalers now have built-in sensors that track when you use them - and whether you did it right. These "smart inhalers" send alerts to your phone if you forget to inhale slowly or hold your breath. They’re still pricey, but insurance coverage is starting to expand.

The bottom line? Your inhaler isn’t broken. You just need to use it right. And once you do, you’ll notice the difference - fewer symptoms, fewer rescue puffs, and better sleep at night.