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Thursday, November 16, 2017

Most Common Inhalers Mistakes

(Shutterstock image)

Last week, Hubby and I had a long awaited vacation to Hawaii. As we were waiting to board the plane, a woman near us started violently coughing and then used her inhaler. 

Hubby leaned over to me and said, "She isn't using a spacer!" I leaned back and said, "She didn't wait one minute between puffs either."

I wondered if I should say something? After all, if you don't use your inhaler the right way, you aren't going to be getting as much medicine as you THINK you are getting.

But would you want a complete stranger walking up to you and say, "I couldn't help but notice you using your inhaler. As a Certified Asthma Educator, I can help you make a few changes that would you allow you to get more medicine from your inhaler. May I show you?" 

I have found that there are Happy Travelers - you know, the kind who look amazing and are full of energy. Then there are those who have obviously had a little Dramamine or a few drinks. Or those who are just plain tired and cranky.

So, I will share the Most Common Inhalers Mistakes here on my blog. (Note - this is for adults and older children. For younger children, it works best to use a spacer with a mask. And they breathe in and out through the spacer for 5-7 times. I'll blog about that next time!)

  1. Not checking the opening of the inhaler for debris 
Why check the opening of your inhaler? Well, I have heard stories of people inhaling a dime, pocket lint, cookie crumbs, etc. Anything floating around in your back pack, purse or pocket can get stuck in your inhaler.

2. Forgetting to shake your inhaler   

When you shake your inhaler, that will mix the right amount of medicine and pressurized air. Kind of like when you have to shake a can a spray paint before you use it so it mixes up. 

2. Not priming your inhaler 

You should shake your inhaler and then spray a puff (or two, or three, or four) into the air. How many puffs you spray depends on the brand of your inhaler and each company is a little different (you should look up the directions for your brand of inhaler.)  American Thoracic Society says that when you prime your inhaler, that makes sure you get the right amount of medicine in the dosing chamber. They also have a nice graphic that shows the inside of an inhaler so you can see how it works.

3. Forgetting to blow out BEFORE you use your inhaler 

You need to empty your lungs FIRST so you can take a big breathe IN and inhale all of the Albuterol. If you forget to do that, it's a little hard to breathe in when there your lungs are already full of air.

4.   Not using a spacer OR not inhaling BEFORE you puff the inhaler  

Okay, there are two options here. 

a. Use a spacer 

This is my choice because I am uncoordinated - I can't walk and chew gum at the same time! If you use a spacer, you just insert the inhaler into the end of the spacer and depress the inhaler. That allows the medicine to go into the spacer/holding chamber and stay there until you inhale it.

b. Inhale BEFORE you depress the inhaler 

Since the medicine in an inhaler comes our REALLY fast (one pharmacist told me it was over 50 miles per hour - or something like that.) So if you depress our inhaler and THEN breathe in, that puff will be at the back of your throat before you even have a chance to breathe in. You should put the inhaler between your teeth, and start to breath in BEFORE you press the inhaler. That way, the air is already swirling and being pulled down into your lungs, and the puff will go right down your lungs with it. 

This is hard to explain, so here's a video that shows How to Use an Inhaler.

5. Not holding your breath after you use your inhaler 

The New England Journal of Medicine listed this as one of the most common mistakes. You don't want to inhale, and then exhale right afterwards or you will blow all of that medicine right back out.
5. Not waiting 1 minute between puffs

 Why can't you do 2 puffs back to back? Well I had to study  "The Asthma Educator Handbook", 
 to prepare for my Certified Asthma Educator exam. In the book, it talks about how your lungs branch out 28 different times. That's a lot of twists and turns for the medicine to go through. A pharmacist explained it this way: The 1st puff will go about 1/2 way through your lungs (will sort of plow the way) and that takes time. If you wait one minute, the 2nd puff can quickly zip through that section of the lungs, then finish plowing to the end of the lungs (where the air exchange takes place.)

6. Forgetting to rinse your mouth after your controller inhaler

Controller inhalers can cause thrush if the medicine stays in your mouth. The doctor and pharmacist should tell you to rinse out your mouth after you using your controller (or maintenance) inhaler. But I always like to know WHY. The why is that you can get thrush. That's where the tongue turns white and you can also get sores on it.

So, I know that's a lot of information. With the families I have worked with, most report feeling better just by changing their inhaler technique. Some people have told me they have had asthma all their life, and they know what they are doing. And yet, they have been using their inhaler wrong for years! Once we play the video showing the proper inhaler technique, they are surprised. If they are willing to try it to change a few things, they are happy to see that they feel better and report that the medicine seems to be helping more. 
Take a minute to see if you are using your inhaler the right way!  


  1. My 3 year old has allergies and cough variant asthma. This is the first winter we are going through where I actually know why she coughs for an eternity and vomits nightly because of it. I am new to managing this, slightly failing it seems. My poor girl she’s had a rough night. I’m glad I found your blog. I have a lot to learn. Do you have a Facebook page?

    1. Hi Erin,

      So sorry to hear you are having a rough time. Asthma definitely has a learning curve!

      Have you circled back to your doctor and mentioned how your little girl vomits nightly? Is it from how hard she coughs?

      Sometimes I cough hard enough that I feel like vomiting too. But it helps when I take my Albuterol (either my inhaler or nebulizer.)That settles my cough down for a few hours. Albuterol helps release the bands around the bronchial tubes that shorten and tighten with asthma. However, it's only temporary - usually 4-6 hours. My Asthma Doc calls it a "bandaid" approach. It will help, but you also need to get the swelling down in your lungs.

      The bronchial tubes swell (think of how thick a pool noodle is - that gives you a good visual of the swelling that happens in asthma.) You can see a visual here:

      It's important to get the swelling down in the lungs - which is treated by a a corticosteroid (a different inhaler or medicine in the nebulizer) like QVAR, Flovent, pulmicort, etc.) I take an inhaler every day that keeps the swelling down in my lungs.

      She should also have an Asthma Action Plan so you know what to do when she is having certain symptoms. Her doctor should fill it out and explain it to you. This version is from American Lung Association

      Have you received any educational materials for her new diagnosis? That's one thing we DIDN'T get when my kids were diagnosed 18 years ago :(

      You can download a copy of "Understanding Asthma" from Allergy & Asthma Network

      The "Download File" button is at the bottom of the page.

      I don't have a FB page for asthma, but there is a FB group called "Asthma" that is worldwide where people can learn from others and ask questions. It is moderated by a Certified Asthma Educator (AE-C) and a Registered Respiratory Therapist (RRT) - both of whom have asthma!

      There is also a FB page and website called ""

      (Full disclosure: I am paid to write for

      I am happy to share anything I know and provide more resources. Good luck!!