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Inhaler Technique

Incorrect inhaler technique is one of the most common reasons inhalers don't work as well as they should. Even experienced patients may develop poor habits over time. Reviewing your technique regularly helps ensure you get the full benefit of your medication.[1]

Types of Inhalers

Understanding your inhaler

There are three main categories of inhalers. Each works differently and requires a different breathing technique. The photos show real devices (yours may differ in color), and each card has a technique video from the American Lung Association.[1,2]

A real albuterol (salbutamol) metered-dose inhaler: metal canister seated in a plastic actuator with mouthpiece

A real albuterol MDI — photo via Wikimedia Commons (free license, see file page for credit).

Metered-dose inhaler (MDI)

The most common type. Uses a pressurized canister to deliver a measured spray of medication.

  • Requires coordination — you must press the canister and breathe in at the same time.
  • Breathe in slowly and steadily (not fast) when actuating.
  • A spacer (valved holding chamber) is strongly recommended and eliminates the need for precise coordination.[2]
  • Shake before each puff (if the medication is a suspension — most are).
  • Prime a new inhaler before first use (spray into the air 3–4 times). Re-prime if not used for several days.
  • Common examples: albuterol (ProAir, Ventolin), fluticasone/salmeterol (Advair HFA), budesonide/formoterol (Breztri Aerosphere).
Video · American Lung Association

Watch: how to use an MDI

A real Seretide 250 Accuhaler (sold as Advair Diskus in the US): a round purple dry powder inhaler

A real Diskus/Accuhaler DPI (Seretide = Advair) — photo via Wikimedia Commons (free license, see file page for credit).

Dry powder inhaler (DPI)

Delivers medication as a fine powder activated by your breath — no propellant, no coordination needed.

  • Breathe in quickly and deeply (opposite of MDI technique).
  • Do not shake DPIs. Do not breathe into the device (moisture can clump the powder).
  • Do not use a spacer with DPIs — they are breath-actuated.
  • Common DPI devices: Diskus (Advair Diskus, Wixela), Ellipta (Breo, Trelegy), Flexhaler (Pulmicort), Handihaler (Spiriva), RespiClick, Inhub.
  • Each DPI device has a slightly different loading mechanism — learn the steps for your specific device.
Video · American Lung Association

Watch: how to use a Diskus DPI

Using an Ellipta, Flexhaler, or another DPI? See the full video list further down this page.

A real Combivent Respimat soft mist inhaler with its cartridge

A real Respimat soft mist inhaler — photo via Wikimedia Commons (free license, see file page for credit).

Soft mist inhaler (SMI)

Produces a slow-moving mist that is easier to inhale than a standard MDI spray.

  • Breathe in slowly and steadily (similar to MDI, not DPI).
  • Does not require a spacer.
  • Requires initial assembly and priming for first use.
  • Common example: Respimat (Spiriva Respimat, Stiolto Respimat).
Video · American Lung Association

Watch: how to use a Respimat

Quick reference: breathing speed

  • MDI (with or without spacer): Breathe in slowly and steadily.
  • DPI: Breathe in quickly and deeply.
  • Soft mist (Respimat): Breathe in slowly and steadily.

This is the most common source of error — using MDI technique with a DPI (or vice versa) significantly reduces medication delivery to the lungs.[1]

Spacers

Why spacers matter for MDIs

A spacer (valved holding chamber) is a tube or chamber that attaches to your MDI. It holds the medication spray so you can breathe it in at your own pace, without needing to time the press-and-breathe coordination perfectly.[2]

A real valved holding chamber (spacer) used with a metered-dose inhaler

A real spacer / valved holding chamber — photo via Wikimedia Commons (free license, see file page for credit).

Benefits of using a spacer

  • More medication reaches the lungs — less is lost in the mouth and throat.[2]
  • Reduces medication deposited in the mouth, which lowers the risk of oral thrush from inhaled corticosteroids.
  • Eliminates the need for precise press-and-breathe coordination.
  • Reduces the cold sensation from the propellant hitting the back of the throat.
  • Recommended for all patients using MDIs, especially for inhaled corticosteroids.[1]
Video · American Lung Association

Watch: MDI with a spacer

Spacer tips

  • Use one puff at a time — press the canister once, then breathe in. Do not put multiple puffs into the spacer before inhaling.
  • Breathe in within 5 seconds of pressing the canister into the spacer.
  • Clean the spacer monthly with warm soapy water. Let it air dry — do not towel dry (static charge can trap medication on the walls).
  • Replace the spacer every 6–12 months or if it becomes cracked or cloudy.
  • Do not use spacers with DPIs or Respimat inhalers — only with MDIs.
Step by Step

How to use an MDI, step by step

These are the standard steps for a metered-dose inhaler without a spacer. If you use a spacer, spray one puff into the chamber and breathe in slowly within 5 seconds.[1,2]

  1. Remove the cap and shakeShake the inhaler well for about 5 seconds. Prime it into the air if it's new or hasn't been used for several days.
  2. Breathe out fullyStand or sit upright, and breathe out all the way — away from the inhaler.
  3. Seal your lips around the mouthpieceHold the inhaler upright with the mouthpiece toward you, canister on top.
  4. Press and breathe in slowlyAs you start a slow, steady breath in, press down on the canister once. Keep breathing in for 3–5 seconds.
  5. Hold your breathHold for 5–10 seconds (or as long as comfortable), then breathe out slowly.
  6. Wait, then repeat if prescribedWait 30–60 seconds before a second puff. Rinse and spit afterward if the inhaler contains a corticosteroid.
A patient sitting upright and using a metered-dose inhaler with sealed lips around the mouthpiece
Upright posture, lips sealed on the mouthpiece. Image: myUpchar, CC BY-SA 4.0, via Wikimedia Commons.

The most common mistakes

  • Breathing in too fast with an MDI — the spray hits the throat instead of the lungs. Slow and steady wins.
  • Breathing in too slowly with a DPI — powder needs a quick, deep breath to leave the device.
  • Forgetting to exhale first — a full lungful of stale air leaves no room for medication.
  • Skipping the breath-hold — medication needs a few seconds to settle in the airways.
  • Using an empty inhaler — an MDI can still spray propellant with no medication left. Check the counter.
  • Not rinsing after steroids — raises the risk of oral thrush and hoarseness.
Maximizing Effectiveness

Getting the most from your inhaler

Technique essentials

  • Sit or stand upright: Good posture opens the airways and allows medication to reach deeper into the lungs.
  • Exhale fully before inhaling: Breathe out completely away from the inhaler, then take your dose. This makes room for a full, deep inhalation.
  • Hold your breath: After inhaling, hold your breath for 5–10 seconds (or as long as comfortable). This gives the medication time to settle in the airways.
  • Wait between puffs: If using 2 puffs of the same inhaler, wait about 30–60 seconds between puffs.
  • Check the dose counter: Do not use an inhaler when the counter reads zero — it may spray but deliver no medication.
  • Ask for a review: Have your clinician or pharmacist watch you use your inhaler at least once a year to check technique.[1]

Mouth rinsing and other tips

  • Rinse your mouth after inhaled corticosteroids: Gargle and spit with water after every use of an ICS-containing inhaler (fluticasone, budesonide, mometasone, beclomethasone, etc.). This reduces the risk of oral thrush (candidiasis) and hoarseness.[1]
  • Order of inhalers: If you use both a rescue inhaler (e.g., albuterol) and a controller inhaler (e.g., ICS or ICS/LABA), use the rescue inhaler first when both are needed — it opens the airways so the controller medication can penetrate more effectively.
  • Store correctly: Keep inhalers at room temperature. Cold temperatures reduce MDI spray output. Do not leave inhalers in hot cars.
  • Track refills: Know when your inhaler is running low. Running out of a controller medication leads to worsening control and potential exacerbations.
  • Clean the MDI mouthpiece: Wipe weekly with a dry cloth. Do not submerge the canister in water.
Video Resources

Watch how to use your inhaler correctly

The American Lung Association provides free, verified video demonstrations for each inhaler type. The Ellipta demonstration is embedded below; every other device is one click away.

Video · American Lung Association

Watch: how to use an Ellipta DPI

Used for Breo, Trelegy, Anoro, and Incruse.

MDI and spacer videos

Dry powder inhaler (DPI) videos

Soft mist inhaler video

Written guides

Related topics

Trusted resources

If your inhaler technique was last reviewed more than a year ago, ask your clinician or pharmacist to observe your technique at your next visit. Small corrections can make a significant difference in symptom control.

References

  1. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2025. Updated November 2025. Available from: ginasthma.org
  2. McIvor RA, Devlin HM, Kaplan A. Optimizing the delivery of inhaled medication for respiratory patients: the role of valved holding chambers. Can Respir J. 2018;2018:5076259. doi:10.1155/2018/5076259