How to Use an Inhaler Correctly: Step-by-Step Guide for Asthma

An inhaler is one of the most effective treatments for asthma — but only if it's used properly. The US National Library of Medicine (MedlinePlus) puts it simply: using a metered-dose inhaler seems simple, but many people do not use them the best way. When used wrongly, less medicine reaches your lungs and most stays in the back of your mouth.

In Bangladesh, many people are also afraid of inhalers, believing they are "addictive" or only for serious illness. In fact, inhaled medicines deliver a small dose straight to the airways. This guide explains how to use an inhaler correctly, asthma basics, and what to do in an attack.

Asthma in Brief

The WHO describes asthma as a chronic lung disease affecting people of all ages, caused by inflammation and muscle tightening around the airways, which makes it harder to breathe. It notes asthma is often under-diagnosed and under-treated, particularly in low- and middle-income countries.

Symptoms (NHS)

• Wheezing
• Coughing
• Shortness of breath
• Chest feeling tight

Symptoms usually come and go, and may be worse at night and early in the morning.

Common triggers (NHS)

• Exercise
• High levels of air pollution
• Cold air and colds or flu (see cold vs flu)
• Allergens like pollen, dust, mould or animals

In Bangladesh, Dhaka's air pollution (see air pollution health effects in Dhaka), dust from construction and roads, smoke from cooking fuel or brick kilns, cigarette smoke and winter cold are common triggers.

Types of Inhalers

• Reliever inhaler — often blue. Works quickly to open the airways during symptoms.
• Preventer inhaler — used every day to reduce airway inflammation, even when you feel well.
• Combination (AIR or MART) inhalers — the NHS describes these as used for both preventing and treating symptoms.
• Metered-dose inhalers (MDI) — spray a measured puff; best used with a spacer.
• Dry powder inhalers — you breathe in a powder; they have different instructions and do not need a spacer (MedlinePlus).

Your doctor will tell you which you have and how often to use it. Always read the leaflet for your specific inhaler.

How to Use a Metered-Dose Inhaler (Without a Spacer)

These steps follow MedlinePlus guidance:

Getting ready

1. If you haven't used the inhaler in a while, you may need to prime it — check the leaflet.
2. Take the cap off. Look inside the mouthpiece to make sure nothing is in it.
3. Shake the inhaler hard 10 to 15 times before each use.
4. Breathe out gently to empty your lungs as much as you can.

Breathe in slowly

5. Hold the inhaler with the mouthpiece down.
6. Place your lips around the mouthpiece to form a tight seal.
7. As you start to breathe in slowly through your mouth, press down once on the inhaler.
8. Keep breathing in slowly, as deeply as you can.

Hold your breath

9. Take the inhaler out of your mouth. Hold your breath while slowly counting to 10, if you can. This lets the medicine reach deep into the lungs.
10. Pucker your lips and breathe out slowly.

Next puff and after

11. For quick-relief (reliever) medicine, wait 1 to 2 minutes before the next puff. For other medicines you don't need to wait.
12. Put the cap back on firmly.
13. Rinse your mouth with water, gargle and spit — don't swallow. This helps reduce side effects.

How to Use an Inhaler With a Spacer

MedlinePlus says if you have a spacer, use it — it helps more medicine reach your airways. Almost all children can use a spacer.

1. Take the caps off the inhaler and spacer; check the mouthpiece is clear.
2. Shake the inhaler hard 10 to 15 times.
3. Attach the spacer to the inhaler.
4. Breathe out gently to empty your lungs.
5. Put the spacer between your teeth and close your lips tightly around it. Keep your chin up.
6. Start breathing in slowly, then press the inhaler once to spray one puff into the spacer.
7. Keep breathing in slowly and deeply.
8. Remove the spacer and hold your breath for a count of 10, if you can.
9. Breathe out slowly through puckered lips.
10. For reliever medicine, wait about 1 to 2 minutes before the next puff.
11. Replace the caps, then rinse, gargle and spit.

No spacer at home?

Ask your doctor or pharmacist about getting one — they are widely recommended, especially for children and during attacks.

Common Inhaler Mistakes

• Not shaking the inhaler
• Pressing the canister before breathing in — or breathing in too fast
• Not holding the breath afterward
• Taking two puffs at once
• Not rinsing the mouth after a preventer
• Using an empty inhaler
• Stopping the preventer when you feel better

Example

Karima, 45, from Narayanganj, uses her blue inhaler several times a day but still feels breathless. When her doctor watches her technique on a video consultation, he sees she sprays first and breathes in afterwards, and doesn't hold her breath. After learning the correct steps and starting a spacer, plus a daily preventer as prescribed, her symptoms improve. Using a reliever more often is a sign asthma isn't well controlled.

Cleaning, Replacing and Storing Your Inhaler and Spacer

Cleaning your inhaler (MedlinePlus)

• If you see powder in or around the spray hole, clean it.
• Remove the metal canister from the plastic mouthpiece.
• Rinse only the mouthpiece and cap in warm water. Let them air-dry overnight.
• Put the canister back in the morning. Do not rinse other parts.

Cleaning your spacer (Asthma + Lung UK)

The spacer used with a metered-dose inhaler (MDI) should usually be cleaned once a month. However, cleaning methods and frequency can vary between spacers. Always follow the instructions in your spacer's leaflet.

• Remove the inhaler from the spacer before cleaning. Take apart any removable spacer parts as directed in the leaflet.
• Gently clean with warm water and a small amount of mild liquid detergent. Do not use boiling water.
• Do not scrub the inside of the spacer.
• Check the leaflet to see whether rinsing is needed — instructions differ between spacers.
• Do not wipe the inside dry with a cloth or tissue; leave it to air-dry completely.
• Once fully dry, put the spacer back together.

Replacing

• Watch the dose counter and replace before it runs out.
• Do not put the canister in water to check if it's empty — this doesn't work.

Storing

• Keep at room temperature. Don't let it get too cold, and don't get it too hot or puncture it — the canister is under pressure. In Bangladesh's summer, don't leave it in a hot car or direct sun.
• Bring your inhaler to appointments so the doctor can check your technique. For online visits, see how to prepare for an online doctor visit.

What to Do in an Asthma Attack (NHS)

1. Sit up straight and try to stay calm.
2. Use your reliever inhaler:
   • Blue reliever: take 1 puff every 30 to 60 seconds, up to 10 puffs. Shake between puffs and use a spacer if you have one.
   • AIR or MART inhaler: take 1 puff every 1 to 3 minutes, up to 6 puffs.
   • If your asthma action plan gives a different maximum, follow your plan.

Call 999 if (NHS):

• You feel worse at any time
• You don't feel better after the maximum dose
• You don't have an inhaler

If symptoms are no better after 10 minutes and help hasn't arrived, use the inhaler again up to the same maximum dose. Do not drive yourself to hospital.

After an attack

The NHS advises seeing a doctor within 2 days even if you feel better, to review treatment and prevent another attack.

When to See a Doctor About Asthma

The NHS advises seeing a doctor if:

• You or your child have asthma symptoms
• Treatments aren't helping, you're needing your inhaler more often, or you need advice about using it
• Symptoms are stopping your usual activities or waking you at night

Frequently Asked Questions

Are inhalers addictive?

No. Inhalers deliver medicine directly to the airways. Asthma medicines are prescribed to control symptoms, not because they cause addiction.

How many puffs of a blue inhaler can I take in an attack?

The NHS advises 1 puff every 30–60 seconds, up to 10 puffs. Call 999 if you're not better or feel worse.

Do I need a spacer?

MedlinePlus says if you have a spacer, use it — it helps more medicine reach the lungs. Almost all children can use one.

How often should I clean my spacer?

Usually, once a month. If your spacer's leaflet gives different instructions, follow those. After cleaning, let it air-dry completely before use.

Why should I rinse my mouth after using an inhaler?

MedlinePlus advises rinsing, gargling and spitting to reduce side effects.

Can asthma be cured?

The WHO says asthma can be managed with the right treatment, though it's a long-term condition.

Can air pollution make asthma worse?

Yes. The NHS lists high air pollution as a trigger.

Get Your Inhaler Technique Checked on ShifaMate

If you have asthma symptoms or your inhaler doesn't seem to work well, you can consult a verified doctor through ShifaMate. Describe your symptoms and how often you use your reliever, and share photos of your inhaler and prescription. A digital prescription may be issued when clinically appropriate. You can also browse ShifaMate doctors.

In a severe asthma attack, follow the steps above and call 999.

References

• MedlinePlus (NIH). How to use an inhaler — no spacer
• MedlinePlus (NIH). How to use an inhaler — with spacer
• NHS. Asthma
• World Health Organization. Asthma (fact sheet)
• Asthma + Lung UK. Spacers — looking after your spacer

This article is for general information and does not replace advice from a qualified doctor.