Most people use their inhaler imperfectly — studies consistently find technique errors in the majority of users, with some reviews putting it as high as 70–90%. Poor technique means medicine landing in your mouth and throat instead of your lungs, which looks exactly like "my inhaler isn't working". Before any treatment gets stepped up, technique is the first thing worth fixing — it's free and takes two minutes to learn.
First: know which type you have
Technique differs by device, and using one device's technique with the other is a top-three error:
- Pressurised metered-dose inhalers (pMDI) — the classic aerosol "puffer" (most blue salbutamol inhalers, Clenil). Needs a slow, steady breath and press-breathe coordination
- Dry powder inhalers (DPI) — Accuhaler, Turbohaler, Ellipta and similar. No propellant; your inhalation does the work, so it needs a quick, deep, forceful breath
pMDI technique, step by step
- Remove the cap and shake well
- Sit or stand upright, chin slightly lifted
- Breathe out fully, away from the inhaler — empty lungs make room for the dose
- Seal your lips around the mouthpiece
- Start breathing in slowly and steadily, and press the canister as you begin the breath — press-then-breathe timing is the classic failure point
- Keep inhaling slowly for 3–5 seconds until your lungs are full
- Hold your breath for up to 10 seconds (or as long as comfortable) — this lets the particles settle in the airways
- Breathe out gently. If a second puff is prescribed, wait 30–60 seconds, shake again, repeat
Using a steroid preventer? Rinse your mouth and spit afterwards to prevent oral thrush and hoarseness.
The spacer: the biggest free upgrade
A spacer is a chamber that clips onto a pMDI. You spray the dose into it, then breathe it in — no coordination needed, larger droplets (which would have hit your throat) drop out in the chamber, and substantially more medicine reaches the lungs. Guidance recommends spacers for steroid pMDIs and during asthma attacks, and frankly they improve delivery for almost everyone using a pMDI. Care basics: wash monthly in warm soapy water, air-dry without rinsing or towelling (static from drying attracts the drug to the plastic), and replace roughly yearly.
DPI technique — the key differences
- Prepare the dose per your device (slide the lever, twist the base, or open the cover — check its leaflet) — don't shake, and keep it upright while loading
- Breathe out fully, away from the device — moisture from your breath clumps the powder
- Seal lips and breathe in quickly, deeply and forcefully from the very start — the opposite of pMDI pace
- Hold your breath up to 10 seconds, then breathe out away from the device
The most common mistakes, ranked
- Not breathing out first (dose lands on full lungs and bounces straight back out)
- Wrong breath speed for the device — slow for pMDI, fast for DPI
- Pressing the canister before or after the breath instead of with it
- No breath-hold afterwards
- Firing two puffs in one breath
- Forgetting to shake a pMDI / shaking a DPI
- Not rinsing after steroid inhalers
- Using an empty inhaler — check the dose counter; a pMDI can still spray propellant with no medicine left
Get your technique checked — properly
Every asthma review should include a technique check with your actual devices — it's one of the highest-value two minutes in respiratory care, and any prescriber can do it on request too. Asthma + Lung UK also hosts excellent device-by-device technique videos worth bookmarking. If your asthma control has slipped, fix technique first; if it's genuinely right and symptoms persist, that's when treatment changes make sense — see signs your asthma isn't well controlled.
Frequently asked questions
How do I know if my inhaler technique is wrong?
Common giveaways: medicine taste filling your mouth, a cold-mist blast at the back of the throat, coughing mid-dose, hoarseness or thrush with steroid inhalers, or symptoms persisting despite "using it loads". Get a prescriber or nurse to watch you use it.
Do I really need a spacer?
If you use a pMDI — especially a steroid one — a spacer meaningfully increases lung delivery and cuts side effects. During attacks, salbutamol via spacer is the recommended method.
How long should I wait between puffs?
Around 30–60 seconds for routine doses, shaking a pMDI again before the second puff. In an emergency, follow your asthma action plan's instructions.
Why do I need to rinse after my preventer?
Steroid particles left in the mouth and throat cause oral thrush and a hoarse voice. Rinse and spit after every steroid dose — or use a spacer, which reduces the deposit in the first place.
References
- Sanchis J, et al. Systematic review of errors in inhaler use: has technique improved over 40 years? Chest. 2016;150(2):394–406.
- Asthma + Lung UK. How to use your inhaler — video guides. asthmaandlung.org.uk.
- NICE/BTS/SIGN. Asthma: diagnosis, monitoring and chronic asthma management (NG245).
- NHS. How to use a spacer. nhs.uk.