There are various kinds of drug inhalers used to treat asthma. However, it is very important to know how your inhaler works in order to best treat your asthma. The following will help you understand how to use the inhaler you have been prescribed.

Tools to help you breathe better

Respiratory diseases like asthma or chronic obstructive pulmonary diseases (emphysema, chronic bronchitis) affect the daily lives of many Canadians. Treating these respiratory illnesses often requires relying on medication that is inhaled (“breathed”). In order to be effective, the medication must reach the bronchi and lungs, and this is made possible with the help of various medical devices. The better a person knows how to properly use their inhaler, the more effective the treatment will be. Below are the features of the main inhalers available on the market.

Metered-dose inhalers with spacer chamber

The inhaler is composed of a cartridge and an inhaler. The cartridge is the container that holds the medication. It is inserted into the inhaler, which includes a mouthpiece and a cover.  

The first time an inhaler is used, or if it has not been used for more than 14 days, it is necessary to arm the apparatus so that the proper dosage is delivered. The inhaler must be shaken vigorously for several seconds, and then the cartridge depressed to release a stream away from the face. This must be repeated until a clear stream appears.

Although it is preferable to use an inhaler with a spacer chamber, it is also possible to do so without the spacer chamber. The spacer chamber optimizes the quantity of medication that reaches the lungs and increases its health benefits in addition to reducing undesirable effects. These two application methods differ on various points and will be discussed separately. 

Below is the proper method for using the inhaler WITHOUT the spacer chamber:

• Shake the inhaler several times.
• Breathe out to empty your lungs completely.
• Place your lips around the mouthpiece (ensure you don’t block it with your tongue).
• While breathing in slowly, depress the cartridge to administer the spray into your mouth. Continue to breathe to fill your lungs with air.
• Hold your breath for approximately 10 seconds.
• Exhale slowly.

Below is the proper method for using the inhaler WITH the spacer chamber:

• Shake the inhaler several times.
• Insert the inhaler into the opening behind the spacer chamber.
• Place your lips around the mouthpiece of the spacer chamber (ensure you don’t block it with your tongue) or, if necessary, adjust the mask to properly cover your mouth and nose, or that of your child if they are to receive the medication.  
• Exhale into the mouthpiece.
• Depress the cartridge to transfer the spray into the spacer chamber. Do not vaporize more than one dose at a time into the spacer chamber.
• Breathe in slowly, deeply and fully. Hold your breath for at least 10 seconds. Children can inhale and exhale normally into the mask up to 6 times.

If you hear a whistling noise while breathing into the spacer chamber, it means that you are breathing too hard. Also, it is recommended that you wash the spacer chamber and the inhaler (after first removing the medication cartridge) approximately once a week with warm water and a mild detergent, and let air dry. You must ensure the devices are thoroughly dried before reusing.  

The Turbuhaler

Unlike the metered dose inhaler, the Turbuhaler is a dry-powder inhaler. This powder is so fine that it can’t be felt when inhaling. It is available in an easy-to-use format:

• Unscrew the cap and hold the inhaler upright.
• Twist the coloured grip of your Turbuhaler to the right as far as it will go. Then twist it all the way back. You have done it correctly when you hear a click sound.  
• Exhale as much air from your lungs as possible.
• Put the mouthpiece between your teeth, and raise your head.
•  Breathe in forcefully and deeply through your mouth.
• Hold your breath for at least 10 seconds, and then exhale slowly.

You must never exhale into the inhaler after its dose has been loaded, as this may cause the dose to be lost. Clean the Turbuhaler mouthpiece with a dry tissue or cloth every 2 or 3 days.

The Diskus

A Diskus also delivers medication in the form of a dry-powder. However, it must be used in a different manner:

• Hold the Diskus in one hand and place the thumb of your other hand on the thumb grip.  
• Slide the lever away from you as far as it will go. This will prepare the mouthpiece.  
• Slide the lever away from you as far as it will go to get your medication ready.
• Exhale as much air from your lungs as possible.
• Place your lips around the mouthpiece.

1. Breathe in forcefully and deeply through your mouth.
2. Hold your breath for at least 10 seconds, and then exhale slowly.
3. To close the Diskus, slide the thumb grip back toward you until you hear a click.

Once the Diskus has been removed from its metal packaging, it must be used within two months. Never exhale into the inhaler, which may cause the dose to be lost. Use a dry cloth to clean the mouthpiece.  

There are other inhalers on the market that have not been described in this document. Ask your pharmacist or the healthcare professional treating you for more information.

Your pharmacist: an invaluable ally

Managing your asthma requires a good understanding of the medication and how to properly administer it. Your pharmacist can provide you with information about your medication, and also show you how to use your inhaler the correct way. Ask your pharmacist to watch as you administer your dose, and to offer any suggestions to help you improve your technique. Your pharmacist can also give you advice on other steps to help you better manage your respiratory illness, and direct you to other resources in the event this becomes necessary.