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Inhaled medications are the basis of treating asthma and COPD — they bring the active ingredient where it's needed: into the lungs. But a considerable proportion of patients inhale incorrectly — and the medication works less well as a result. The inhalation technique is the most common application error in respiratory therapy.
With inhaled medications, the technique decides whether the active ingredient reaches the lungs at all. If you inhale incorrectly, a large part gets stuck in the mouth and throat or is swallowed — and doesn't work there.¹
The good news: the inhalation technique can be learned and improved. Even small corrections can make a big difference. So it's worth checking your own technique regularly — even if you've been inhaling for a long time.
Before we get to the technique, it's important to understand what you inhale. With asthma and COPD there are two fundamentally different types of inhaled medication:¹
This distinction is important: the controller is inhaled regularly according to a plan, the reliever as needed. Both require the correct inhalation technique. More on the controller principle in the guide on Cortisone as well as on the pages about Budesonide and Salbutamol.
There are various inhaler systems that differ markedly in their use. It's important to know your own type and its correct technique:
The exact technique depends on the device type. When it's prescribed, have your specific device explained in detail and shown to you — and practice it. In the following, we go through the most common types.
The metered-dose inhaler is widespread, but also error-prone — because releasing the puff and inhaling have to be coordinated. Here's how to do it correctly:
The hardest part is the coordination of releasing and inhaling. Anyone who has trouble with this (e.g. children, older people, during an acute attack) benefits enormously from a spacer (next chapter), which makes this coordination unnecessary. With cortisone-containing sprays, afterwards rinse your mouth.
The spacer (inhalation aid) is one of the most effective and most underrated helps when inhaling with the metered-dose inhaler. It's a chamber placed between the spray and the mouth:¹
With the dry powder inhaler, the active ingredient is drawn into the lungs as a fine powder by your own breath. The technique differs from the metered-dose inhaler — here no spray coordination is needed, but a forceful, deep breath is:
The most important difference: with the metered-dose inhaler you inhale slowly, with the dry powder inhaler forcefully and quickly. A breath that's too weak is the most common mistake with the dry powder inhaler — the powder then doesn't get deep enough into the lungs. Here too: never breathe out into the device, and with cortisone afterwards rinse your mouth.
These mistakes occur most frequently — and can all be avoided:
A simple but important step — especially after inhaling cortisone (e.g. budesonide). Part of the active ingredient stays behind in the mouth and throat and can cause side effects there:
This small routine prevents the most common local side effects of the inhaled cortisone. With pure bronchodilators (relievers), rinsing the mouth is less critical, but doesn't hurt. More on this on the page about Budesonide.
In children with asthma, correct inhalation is especially important — and especially challenging, because coordination is difficult. Here the spacer is almost always the solution:
Parents should have the technique shown to them in detail and check it regularly. A well-fitting spacer with a mask is what first makes inhaling reliably possible in small children. The pediatrician discusses the age-appropriate dose and device choice.
Older people too often have difficulties with the inhalation technique — due to declining coordination, strength or cognitive limitations:
Choosing the right type of inhaler is especially important in older people — not every device suits everyone. If use is difficult, it should be discussed with the doctor instead of doing it "somehow". Often there's a more suitable system.
A clean inhaler works better and is more hygienic. The care is simple, but often forgotten:
A dirty or blocked mouthpiece can impair the delivery of the active ingredient. The exact cleaning instructions are in the relevant device's instructions for use — the devices differ here.
The inhalation technique should be checked regularly — not just at the beginning:
A brief check of the technique costs little time but can significantly improve the effect of the therapy. Don't hesitate to ask at the pharmacy or the doctor and have the use shown to you — that's a normal and sensible part of treatment.
An inhalation therapy has a few pitfalls: the controller has to be taken regularly (even without symptoms), rinsing the mouth after cortisone is easily forgotten, and a high reliever use is a warning sign. This is exactly where brite comes in:
Use reminders
Remember the regular inhalation of the controller (long-term medication) — crucial, because it has to be used even without symptoms.
A reminder to rinse the mouth
Don't forget the important routine after inhaling cortisone.
Usage tracking
Keep an eye on the use of the reliever spray — frequent use is a warning sign of insufficient control.
Health history
Document symptoms and the need for the emergency spray — valuable for the doctor's appointment and for assessing asthma/COPD control.
Digital medication plan
Controller and reliever clearly laid out for the doctor and pharmacy.
Controller reminders even without symptoms, don't forget to rinse the mouth, reliever use in view — the small routines that decide your asthma and COPD control.
