Asthma Inhaler & Spacer Technique: Guide For Asthmatics

For some, using inhalers can be tricky. Studies suggest that up to a third of asthma sufferers aren’t using their inhalers correctly. Ensuring you are using the correct technique is essential for receiving the full dose of medicine from your inhaler. A poor technique could result in the medicine not reaching the lungs as desired; instead, it could be hitting the back of the throat or lingering in the mouth and on the tongue. Incorrect usage will not only fail to relieve your asthma symptoms, but also could lead to further complications such as oral thrush or a sore throat.

There are many different types of asthma inhalers, with some requiring a different technique to others. Your GP or asthma nurse will be able to talk you through your options. Finding an inhaler that you find easy to use will help encourage a good technique. Below is a list of the different inhaler devices available:

• Metered Dose Inhalers (MDIs): these are often referred to as ‘puffers’. An MDI inhaler has a small canister that contains the medicine along with a gas that turns the medicine into a fine spray when activated. The dose is administered by pressing down on the canister. These inhalers work better with a spacer device. Spacers are designed to collect the medicine inside them, which means you don’t have to coordinate your breathing with the inhaler puff. Examples of MDIs are Ventolin, Airomir, Clenil, and Qvar inhalers.
• Breath Actuated MDIs: these types of devices are usually reserved for those who find the standard MDIs too difficult. These inhalers are activated by the user’s breath. The metered is dose is delivered by simply breathing in normally through the mouthpiece. It does not require coordination or manual activation. Easi-Breathe and Autohalers are examples of breath actuated inhalers.
• Dry Powder Inhalers (DPIs): these types of inhalers release their medicine in a very fine powder form. To successfully deliver the medicine to the lungs you will need to breathe in fairly hard when using these types of inhalers. Examples of DPIs include Easyhalers, Turbohalers such as Bricanyl, Diskhalers, Clickhalers, and Accuhalers.

Spacer devices: a spacer device is typically a small plastic chamber that connects to your inhaler. It is designed to be used with metered dose inhalers that are not breath actuated. After the canister on the MDI has been pressed, the dose is released from the inhaler into the spacer device. The other end of the spacer has a mouthpiece from which the recipient of the intended dose can slowly and deeply inhale the medicine. Using a spacer device can dramatically decrease the amount of medicine deposited at the back of the throat, in the mouth, and on the tongue. A spacer will usually be recommended if the patient has difficulty timing their spray with their inhalation.

How to use your metered dose inhaler

1. Remove the cap from the mouthpiece
2. Check to make sure there is still medicine in the canister
3. Shake the inhaler to properly mix the medicine with the propellent
4. Ensure your tongue is placed under the mouthpiece so that it does not obstruct the opening
5. Remember to breathe through the mouth and not the nose
6. Take a deep, slow breath as you press down on the medication canister
7. Hold your breath for approximately 10 seconds after inhalation (or as long as is comfortably possible)

How to use your dry powdered inhaler

1. Remove the cap from the mouthpiece
2. If using a single-use device, load a capsule into the device as instructed
3. Exhale slowly and completely (away from the mouthpiece)
4. Position the mouthpiece between the front teeth and seal your lips around it
5. Breath in quickly and deeply through the mouth for 2-3 seconds
6. Remove the inhaler from your mouth and hold your breath for 10 seconds (or as long as comfortably possible)
7. Exhale slowly.

How to use a spacer device

1. Assemble the spacer
2. Remove the cap from your inhaler
3. Ensure there is enough medicine in your inhaler to administer a dose
4. Shake your inhaler holding it upright
5. Insert your inhaler upright into the spacer device
6. Place the mouthpiece between your teeth (without biting), closing your lips around it to form a good seal
7. Exhale gently into the spacer
8. Keeping the spacer horizontal, press down firmly on your inhaler canister once
9. Single breath method - breathe in slowly and deeply
10. Multi breath method - inhale and exhale normally for 3-4 breaths
11. Hold your breath for 5-10 seconds or as long as you can comfortably manage
12. Whilst holding your breath, remove the spacer from your mouth
13. Exhale gently
14. Disconnect your inhaler from the spacer device
15. Replace the cap on your inhaler mouthpiece

Common asthma inhaler mistakes

When it comes to inhaler techniques there are some very common mistakes that people make. Some of these mistakes are specific to a certain device, and others apply to all types of inhalers. Below we highlight these mistakes and how you can rectify and optimise your inhaler technique:

Applies to all inhalers

• Not exhaling first: remembering to fully exhale is important for creating optimal space in your airways. This will allow you to breathe in deeper and longer as your dose is administered. This will give the medicine the best chance of reaching the small airways deep inside the lungs.
• Failure to hold your breath after administering your dose: your GP or asthma nurse may advised you to ‘hold your breath’ after inhaling the medicine. This will help to keep your airways still and will allow more time for the medicine to reach the lungs. Holding your breath for 10 seconds is ideal, however, if this is not possible, then holding your breath for as long as is comfortable will still provide some benefit.

Applies to MDI inhalers

• Failure to shake your inhaler prior to and in between doses: if you fail to properly shake the canister, the medicine and the propellant (the gas that turns the medicine into aerosol form) will not mix together properly. This will likely result in either too much or too little of one being released.
• Inhaling too early - If your breath is not properly timed with the administration of your dose, you will likely not have enough breath to inhale all of the medicine. If this happens, a portion of your dose will instead end up at the back of your throat and in your mouth and not in the lungs where it is needed.
• Inhaling too late - Once activated it takes under half a second for the medicine inside the inhaler to be released. If your intake of breathe is too late then some of your dose will end up being sprayed into the mouth, not making it to the lungs.
• Not leaving sufficient time between doses - A good technique will require the canister to be properly shaken between doses, followed by waiting at least 30 seconds before taking the next dose. This is to allow the medicine and the propellent enough time to properly mix together.

Getting the best out of your inhaler

Below you will find some simple tips that will help ensure you are getting the most out of your inhalers. Adopting a good inhaler technique will allow you to receive the right dose of your medicine, which will better control your asthma symptoms.

• Check your technique in between asthma reviews: reviewing your technique and reminding yourself of each important step will help ensure your technique remains optimal. You can pop to see your local pharmacist at any time and they will be happy to review your technique.
• Store your inhaler(s) correctly: always replace the mouthpiece after use, and avoid storing your inhaler in extreme temperatures. Never leave your inhaler somewhere where it may get too hot or too cold. Check the label of your inhaler for the correct storage conditions.
• Clean your inhalers the correct way: maintaining your inhalers properly and keeping them clean will help keep them hygienic and effective. The patient information leaflet (PIL) will outline the best ways to clean, store and look after your device.

Cleaning your inhaler

1. Remove the canister and mouthpiece cap. Do not immerse or wash the canister in water
2. Run warm water through the top and bottom of the actuator for approximately 30 seconds
3. Check that any medicine build-up has been washed away from the mouthpiece. If there is still a build-up present, repeat step 2
4. Shake off the excess water and allow to air-dry overnight
5. Once dry, replace the canister into the actuator and spray once (away from face) to test
6. Your inhaler should be cleaned at least once a week.

Cleaning your dry powdered inhaler

1. Most dry powdered inhalers should not be cleaned with soap and water
2. Clean the mouthpiece using a dry cloth
3. Consult the information leaflet for further instructions.

Cleaning your spacer device

1. Wash the spacer using a diluted solution of water and dishwasher detergent. Using just water will cause a electrostatic charge to develop, which will reduce the effectiveness of the spacer
2. Allow to air-dry before next use. The spacer should not be dried using a towel or cloth
3. Your spacer device should be cleaned once every 1-2 weeks.

Correct inhaler usage is an important skill for any asthmatic to acquire. Make sure you use yours correctly and keep it clean to get the most out of your asthma treatment. Incorrect inhaler practices can be detrimental to your health, so brush up on yours today!