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Three types of inhalers: How to use inhalers.
Health Education

How to use your inhaler

Common inhaler types and how to use, clean, and store them
Megan Huang, PharmD, medical writer and reviewer
By | Jan. 4, 2023

Common inhalers | Metered dose inhalers (MDIs) | Metered dose inhalers with spacer | Dry powder inhalers (DPIs) | Soft Mist Inhalers (SMIs)

If you have ever seen a drug commercial for an inhaled medication, you may have wondered just how to use an inhaler. With the development of new ways to deliver medication to the lungs, trying to figure out how to use your inhaler can be tricky. Specialist respiratory nurse Carol Stonham recommends that individuals who have an inhaler know how to use the device themselves, review their inhaler technique regularly, and involve their provider or pharmacist whenever they have questions. Keep reading to find out how to use any inhaler that you are prescribed. 

Common inhalers

For individuals with asthma or chronic obstructive pulmonary disorder (COPD), inhaled medications are the most common form of treatment. There are three main types of inhalers: metered dose inhalers (MDIs), dry powder inhalers (DPIs), and soft mist inhalers (SMIs). Each type of inhaler requires a different technique to properly use the inhaler. Furthermore, each type of inhaler has its own advantages and disadvantages, which will be discussed below. 

Metered dose inhalers (MDIs)

MDIs release a mist of medicine when you press a button on the inhaler. Metered dose inhalers are usually made up of 3 parts: a metal canister that contains the medicine, a plastic holder to house the canister, and a plastic cap that covers the mouthpiece, which is where you breathe in the medicine. Some examples of MDIs are Ventolin HFA, Flovent HFA, and Atrovent HFA. Prior to using an MDI, it is important to ensure that the inhaler is at room temperature. The next step is to prime the inhaler. 

How to use an MDI step-by-step

How to prime the inhaler:

  • Take the cap off of the mouthpiece by squeezing the sides of the cap and pulling it straight out.
  • Shake the inhaler well.
  • Spray the inhaler one time into the air away from your face (especially avoiding the eyes)
  • Wait a few seconds, shake the inhaler, and spray the inhaler away from your face two more times.
  • After you have primed your inhaler, you do not need to prime it again unless it has not been used for more than two weeks.

How to hold the inhaler:

  • First, ensure that the metal canister fits firmly within the plastic holder.
  • Take the cap off of the mouthpiece and look inside the mouthpiece to ensure there are no foreign objects.
  • Hold the inhaler with the mouthpiece down and shake the inhaler well.

How to use the inhaler:

  • Breathe out as much air as you can and tilt your chin up slightly.
  • Put the mouthpiece into your mouth and close your lips around it.
  • Push the top of the metal canister firmly all the way down.
  • At the same time that you press down, inhale deeply and slowly through the mouthpiece.
  • After you have inhaled the spray, take the inhaler out of your mouth and close your mouth.
  • Hold your breath for about 10 seconds, or as long as you are comfortable. 
  • Breath out slowly and cap the mouthpiece if you are finished.

Ask your doctor if your medication is a ‘corticosteroid’. If it is, ensure that you rinse and spit with water afterward to remove any medication that remains in the mouth.

If you need another spray:

  • Wait one minute and shake the inhaler again.
  • Repeat the above steps.

Cleaning an MDI

It is important to clean your metered dose inhaler regularly to prevent medication build-up and blockages. The usual recommendation is to clean the mouthpiece at least once weekly. The steps to cleaning an MDI are as follows:

  • Remove the medication canister and cap from the mouthpiece. Do not wash the canister.
  • Hold the plastic holder under a faucet and run warm water through it for about 30 seconds.
  • Turn the holder upside down and run warm water through the mouthpiece for about 30 seconds.
  • Shake off the excess water from the plastic holder and ensure that any medication buildup within the holder has been washed away.
  • Let the plastic holder air-dry overnight.
  • When it is dry, put the cap on the mouthpiece and then put the canister back in place.
  • Shake the inhaler well, remove the cap, and spray the inhaler away from your face one time, and it is ready for use.

Metered dose inhalers with spacer

Because a breath needs to be taken at the same time that the canister is pushed down, some individuals may find it difficult to correctly time the administration of a dose using an MDI. For children and older adults who need to use an MDI, adding a spacer to the inhaler may be helpful to get a full dose of the medication. Spacers are devices that can be attached to an MDI to allow the medication to stay within a closed space for longer, so that the individual has more time to breathe it in.

How to use a spacer:

  • Remove the mouthpiece cover and attach the spacer to the mouthpiece.
  • Breathe out as much air as you can and tilt your chin up slightly.
  • Put your lips and teeth over the spacer and breathe in slowly. 
  • As you breathe in, squeeze the top of the canister once. 
  • Continue to inhale slowly and deeply.
  • After you have taken a full breath, remove the spacer from your mouth.
  • Hold your breath for about 10 seconds, or as long as you are comfortable.
  • Breath out slowly and cap the mouthpiece if you are finished.

Dry powder inhalers (DPIs)

DPIs administer medication in the form of a dry powder when you breathe in. Unlike with MDIs, when using a DPI, you do not need to coordinate pressing the canister with inhaling. However, dry powder inhalers require a more forceful inhalation than MDIs. For this reason, these inhalers may not be suitable for older adults or individuals with nerve or muscle weakness. 

There are two main types of DPIs

  • Multiple dose devices, which contain up to 200 doses. An example of this is Advair Diskus.
  • Single dose devices, which require placement of a capsule in the device immediately before each dose. An example of this is Spiriva Handihaler. 

How to use a DPI step-by-step

Each DPI has its own instructions. For more specific directions on how to use your specific inhaler, make sure to check the manufacturer’s label for guidance. The below instructions are general guidelines for using a DPI:

  • Remove the cap. For single-use devices, load a capsule into the device as directed.
  • Breathe out slowly and completely away from the mouthpiece.
  • Place the mouthpiece between the front teeth and seal the lips around it.
  • Breathe in through the mouth quickly and deeply.
  • Remove the inhaler and hold your breath for about 10 seconds or as long as possible.
  • Breathe out slowly and replace the cover of the mouthpiece.
  • Repeat the dose if your doctor has prescribed more than one inhalation. 

Ask your doctor if your medication is a ‘corticosteroid’. If it is, ensure that you rinse and spit with water after the inhalation to remove any medication that remains in the mouth.

How to clean a DPI

  • DPIs should not be washed. Generally, only the mouthpiece can be cleaned with a dry cloth. However, please read the instructions provided by the manufacturer for specific cleaning procedures. 

Soft Mist Inhalers (SMIs)

SMIs release medication in a fine mist that comes out more slowly than the spray produced by MDIs. As a result, these inhalers do not depend on how quickly you are able to inhale. SMIs all come with a dose-counter built into the device, which turns red when the inhaler is almost empty. Once all the medication has been used, the inhaler will automatically lock itself. Some examples of SMIs are Spiriva Respimat, Pulmicort Flexhaler, and Striverdi Respimat. 

How to prime an SMI: 

  • Hold the inhaler upright with the cap closed.
  • Twist the clear base at the bottom to the right until it clicks.
  • Open the cap and point the mouthpiece to the floor, away from your face.
  • Press the button on the side until you see a mist come out.
  • Repeat the above steps three more times.
  • If it has been three days since you last used your inhaler, you will need to prime it again only one time. If it has been more than three weeks since the last time you used your inhaler, you will need to prime it all over again (releasing four total sprays following all the steps above).

How to use your SMI:

  • Hold the inhaler upright with the cap closed. (You do not need to shake an SMI).
  • Twist the clear base at the bottom to the right until it clicks.
  • Open the cap.
  • Breathe out slowly and completely.
  • Put the mouthpiece in your mouth, holding the inhaler horizontally.
  • Close your lips around the mouthpiece without covering the air vents on the sides.
  • Start to breathe in slowly. As you inhale, press the button on the side of the device and continue inhaling for 3-5 seconds or as long as you are comfortable.
  • When your lungs are full, hold your breath for 10 seconds or as long as you are able to.
  • Take out the inhaler and breathe out slowly.
  • Repeat the above steps for additional doses. 

Ask your doctor if your medication is a ‘corticosteroid’. If it is, ensure that you rinse and spit with water after the inhalation to remove any medication that remains in the mouth.

How to clean an SMI:

  • Once a week, use a clean, damp cloth to wipe the inside and outside of the mouthpiece.

Determining when an inhaler is empty or should be replaced:

Most MDIs nowadays are equipped with a dose counter that helps track the amount of medication used. If the inhaler does not have a dose counter, and you do not use the inhaler every day, it can be difficult to determine when you should replace your inhaler. If you only use your inhaler as needed, it is a good practice to write the date that you start using it on the canister itself. If you use your inhaler on a regular schedule, you can calculate how many doses you have until you run out. For example, Flovent HFA comes with 120 actuations, or doses. (This number will be listed somewhere on the box). If you know that you will use four puffs every day, then by dividing 120 by four, the canister should last about 30 days. In fact, most inhalers are designed to last a person at least 30 days. However, it is best to double-check with your provider or pharmacist if you are unsure. Virtually all DPIs and SMIs come with dose counters, so you will know how many doses are left in these types of inhalers. Regardless of whether or not you use all the medicine, it is recommended to consider replacing your inhaler after 3-4 months. An inhaler should not be used after the specified number of doses have been discharged or after it has reached the expiration date.

How to store inhalers

MDIs

All metered dose inhalers should be stored at room temperature with the mouthpiece down. Because the contents of the canister are pressurized, it is important not to puncture the metal canister. Do not keep the inhaler near heat or open flame. 

DPIs and SMIs

Keep your inhaler in a cool, dry place. Do not take the inhaler apart or try to wash the inhaler. 

Save with SingleCare

Because there are so many inhalers on the market, insurance may not cover the inhaler you are prescribed. If that is the case, SingleCare may have a coupon that can lower the costs of your next inhaler. Check out the pharmacy finder to find a pharmacy near you that accepts SingleCare discount cards and coupons.

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