Why inhaler technique matters so much

Inhalers are powerful medicines – but only if the medicine actually reaches your lungs. Many studies have shown that a large number of people, of all ages, do not use their inhalers as effectively as they could. This is not because they are “stupid” or “careless”; often, no one has ever taken the time to show them slowly and clearly.

Even small technique issues – breathing in too fast or too shallowly, not sealing your lips properly, or not holding your breath afterwards – can mean that much of the medicine ends up on your tongue or in the air instead of in your airways.

Good technique can help:

• Reduce symptoms such as cough, wheeze and breathlessness.
• Cut down flare-ups and urgent visits to your GP or hospital.
• Make the most of each prescribed dose (and avoid unnecessary changes in medicine).
• Give you more confidence and a sense of control over your condition.

Different types of inhaler – why speed and timing matter

There are many different inhaler devices. They can look similar on the outside but behave very differently when you use them. Your pharmacist can tell you exactly which type you have, but it helps to know some general patterns:

• Pressurised metered-dose inhalers (pMDIs) – sometimes called “puffers”. Usually need a slow, steady in-breath started just after pressing the canister.
• Dry powder inhalers (DPIs) – come in several shapes and brands. Often need a quicker, stronger in-breath to pull the powder into your lungs.
• Soft mist inhalers – produce a fine mist over a slightly longer time, but still require correct coordination.
• Spacers – plastic or metal chambers used with certain puffers to make timing easier and help more medicine reach the lungs.

Because each device works differently, there is no single “right” way for everyone. The “right” technique is the one that matches your specific inhaler and your breathing pattern – something your pharmacist and nurse can help you to fine-tune.

Common inhaler mistakes (and how to talk about them)

It can feel awkward to admit that you are not sure about your inhaler technique, especially if you have used it for years. But almost everyone makes at least one of these mistakes at some point:

1. Breathing in at the wrong speed

• Taking a very fast “gasp” with a puffer instead of a slow, steady breath.
• Breathing in too gently with a dry powder inhaler, so the medicine does not move properly.

2. Getting the timing wrong

• Pressing the puffer before you breathe in, so the medicine sprays into the air.
• Pressing the puffer after you have already finished breathing in.
• Taking multiple puffs very quickly, without giving yourself time to breathe out and reset.

3. Not preparing the inhaler properly

• Not shaking certain puffers before use (if advised to do so).
• Not checking dose counters or forgetting to prime new devices as instructed.

4. Missing key steps after the puff

• Not holding your breath for a few seconds after breathing in (if safe for you).
• Breathing out immediately, which can push the medicine back out.
• With steroid inhalers, not rinsing your mouth afterwards, which can increase the risk of throat irritation or oral thrush.

Every one of these issues is something your pharmacist has seen many times before. For them, this is everyday work – not a sign that you have failed.

How to ask for a demonstration without feeling embarrassed

Many older adults worry that staff are too busy, or that asking for help will make them look “silly”. In reality, pharmacists regularly review inhaler technique and would much rather spend a few minutes now than see you back in crisis later.

You might find it easier to use simple, direct phrases such as:

• “I’ve used this inhaler for years, but I’m not sure I’m still doing it right. Could you watch me once?”
• “My breathing has been worse lately. Can we check my technique before we change the medicine?”
• “I get confused about when to breathe in. Can you show me slowly, step by step?”
• “Could we go over the leaflet together? I find the diagrams a bit confusing.”

If you feel rushed at the counter, you can ask:

• “Is there a quieter time I could come back for an inhaler check?”
• “Do you offer inhaler technique reviews or medicines use reviews?”

Preparing for a brief pharmacy review

A few minutes of preparation at home can make your inhaler conversation smoother and more useful. You might:

• Gather all your inhalers and spacers, including older ones you are not sure about.
• Write down roughly how often you use each one (every day, only during flare-ups, rarely, never).
• Note any side effects – sore throat, hoarse voice, tremor, palpitations, headaches.
• Think about what you want to improve: fewer night-time symptoms, fewer emergency visits, less worry.
• Take a photo on your phone of any dose counters or small-print instructions you struggle to read.

Questions you can take with you

When you are at the counter, it can be easy to forget what you meant to ask. Writing your questions down in advance can reduce that pressure. Some ideas:

• “Could you watch me use my inhaler once and tell me if there is anything to improve?”
• “Should I be breathing in slowly or quickly with this particular device?”
• “Is a spacer helpful for me? If so, which one should I use and how do I clean it?”
• “Do I need to rinse my mouth after this inhaler? If yes, am I doing it correctly?”
• “What should I do if I miss a dose, or if I realise I’ve been using it the wrong way for a while?”
• “How can I tell if my inhaler is nearly empty, especially if there is no counter?”

You can show this list to the pharmacist and say, “These are the things I am worried about – could we go through them together?” This helps them understand what matters most to you.

Inhalers, breathlessness and confidence

Using your inhaler correctly does not mean you will never feel breathless again. Illnesses such as asthma, COPD and heart failure can be complex, and there are many factors involved. But getting the technique right gives your medicines the best chance to help.

It can also ease some of the emotional load. Knowing that you are using your inhaler well means that if symptoms continue, you and your team can focus on the next steps – adjusting doses, reviewing triggers, exploring rehabilitation – rather than wondering if the medicine is even reaching your lungs.

You do not have to make these changes alone. Your pharmacist, GP, specialist nurse and rehabilitation programmes are there to support you. PHAT’s gentle Zoom sessions can also provide a space to talk about routines, positions and breathing patterns in a friendly, non-judgemental environment.

Connected PHAT guides for breathing and medicines

Inhalers are just one part of the picture. Understanding breathlessness, positions, routines and clinic visits can all help you feel more prepared. The Primary Health Awareness Trust is building a linked set of guides so you can explore these topics gradually.

Trusted information & where to go next

There is a lot of inhaler advice online, and not all of it is accurate. The resources below come from UK-based charities and NHS-backed organisations, and are intended to sit alongside guidance from your own health team.