Using a COPD inhaler correctly means the medicine actually reaches your airways instead of coating the back of your throat. The technique varies depending on which type of inhaler you have, but the core principles are the same: prepare the device, empty your lungs fully, deliver the medicine with the right breathing pattern, and hold your breath so it settles deep into your lungs. Getting even one of these steps wrong can significantly reduce how much medication you receive.
Know Your Inhaler Type
Most people with COPD use one of three inhaler designs, and each requires a different breathing technique. A metered dose inhaler (MDI) is the classic L-shaped device with a pressurized canister that sprays a measured puff of medicine. A dry powder inhaler (DPI) holds medication in powdered form and relies entirely on the force of your breath to pull it into your lungs. A soft mist inhaler (like the Respimat) creates a slow-moving mist that’s easier to inhale than the fast spray from an MDI.
You may also have more than one inhaler: a rescue inhaler for sudden breathlessness (short-acting, works within minutes) and a maintenance inhaler you use daily to keep symptoms under control. Your maintenance inhaler won’t help during a sudden flare-up, and using your rescue inhaler as a daily treatment won’t prevent symptoms from coming back. Knowing which is which matters.
How to Use a Metered Dose Inhaler
Sit up straight or stand. Slouching compresses your lungs and limits how deeply you can inhale. Remove the cap and shake the inhaler vigorously, about 10 to 15 times, to mix the medication with the propellant. If the inhaler is new or hasn’t been used in a while, you’ll need to prime it first (more on that below).
Breathe out completely to empty your lungs. Place the mouthpiece in your mouth and close your lips tightly around it. As you start to breathe in slowly, press down firmly on the canister to release one puff. Continue breathing in slowly for 3 to 5 seconds, taking as big a breath as you can. Then hold your breath and count to 10. Remove the mouthpiece and exhale. If you need a second puff, wait one minute before repeating the process.
Timing the press with the start of your breath is the trickiest part. If you press too early or too late, most of the medicine hits your mouth and tongue instead of traveling into your lungs.
Why a Spacer Helps
A spacer is a tube or chamber that attaches to your MDI and holds the sprayed medicine in a small reservoir so you can inhale it at your own pace. This solves the coordination problem. You spray one puff into the spacer, then breathe in slowly from the chamber. Spacers increase the amount of fine medication particles that reach your lungs, reduce the amount deposited in your throat, and lower the risk of side effects like throat irritation and oral thrush from steroid inhalers. For older adults with COPD especially, an MDI without a spacer is rarely the best option. Only spray one puff into the spacer at a time, not multiple puffs, since stacking doses reduces how much you actually inhale.
How to Use a Dry Powder Inhaler
DPIs don’t spray anything. The powder only leaves the device when you inhale hard enough to pull it out. That means the breathing technique is the opposite of an MDI: instead of breathing in slowly, you need to take a fast, deep, forceful breath through the mouthpiece. Take as big a breath as possible.
The exact loading steps depend on the device. Some require you to twist a base, others need you to slide a lever or click a button to load the dose. Whatever the mechanism, the sequence is: load the dose, breathe out fully (away from the mouthpiece so you don’t blow powder out of the device), seal your lips around it, and inhale hard and deep. Hold your breath for about 10 seconds, then exhale. Never wash a DPI with water. Moisture clumps the powder and can stop the inhaler from working. Wipe the mouthpiece with a clean, dry cloth instead.
How to Use a Soft Mist Inhaler
Soft mist inhalers require more setup the first time but are straightforward once assembled. For initial assembly, you press down the safety catch, pull off the clear base, and push the medication cartridge (narrow end first) into the inhaler on a firm surface until about an eighth of an inch remains visible. Click the base back into place. Once the cartridge is inserted, don’t remove it, and don’t remove the clear base again.
Priming a soft mist inhaler for first use takes several steps. Hold the inhaler upright with the cap closed, turn the clear base in the direction of the arrows until it clicks, open the cap, point the inhaler toward the ground, and press the dose release button. Repeat this turn-open-press cycle until you see a visible cloud of mist, then do it three more times. This fills the dosing system so it delivers the correct amount of medication.
For daily use, the turn-open-press cycle is the same, but you inhale the mist instead of spraying it at the ground. Breathe out fully, seal your lips around the mouthpiece, press the dose release button while breathing in slowly, and hold your breath for 10 seconds.
Priming: When and How Often
Priming means spraying a few puffs into the air before using the inhaler so the first dose you actually inhale is accurate. Every new MDI needs priming, typically 3 to 4 test sprays. After that, you need to re-prime only if the inhaler sits unused for a certain period, and that window varies by medication.
For common rescue inhalers like albuterol (ProAir, Ventolin, Proventil), re-priming is needed after about two weeks of non-use, with 3 to 4 sprays. Some medications have shorter windows. Combination inhalers like Symbicort need re-priming after 7 days, Dulera after 5 days. Check the insert that came with your specific inhaler, since the number of priming sprays and the non-use threshold differ from one brand to the next.
The Most Common Mistakes
Inhaled medicine only works if it reaches your airways. These are the errors that prevent that from happening:
- Not shaking the MDI. Shake vigorously 10 to 15 times before each puff. The medication and propellant separate when the inhaler sits still.
- Breathing in too fast with an MDI (or too slow with a DPI). MDIs need a slow, steady 3 to 5 second inhalation. DPIs need a fast, forceful breath. Mixing these up means less medicine gets where it needs to go.
- Not holding your breath. Counting to 10 after inhaling gives the medication time to settle into your airways instead of being immediately exhaled.
- Slouching. Sitting up straight or standing lets your lungs expand fully, which improves both how much air you take in and how deep the medicine travels.
- Using an empty inhaler. Even when the medication runs out, most MDIs still make a sound when shaken (from leftover propellant gas) and still release some spray. You can’t rely on sound or spray to judge whether medicine is left.
How to Tell When Your Inhaler Is Empty
The most reliable method is dose counting. Every canister lists how many puffs it contains. If you use the same number of puffs daily, you can calculate the date it will run out and request a refill when about 30 doses remain. Some DPIs, like the Diskus, have a built-in counter that shows remaining doses. Others use a color indicator: the Turbuhaler, for instance, shows a red marker in a window when 20 doses are left.
An older method is the float test: remove the canister, drop it in water, and see if it sinks (full), floats at an angle (half full), or floats flat (empty). This works in a rough sense, but it can’t reliably distinguish between “nearly empty” and “completely empty,” so it’s best used as a backup rather than your main tracking method.
Cleaning Your Inhaler
Medicine buildup can clog the mouthpiece and reduce the dose you receive. Clean your inhaler at least once a week.
For MDIs, pull the metal canister out of the plastic housing and remove the mouthpiece cap. Rinse only the plastic parts under warm running water for 30 seconds. Let everything dry completely before reassembling. Never get the metal canister wet. Once it’s back together, test it with one spray into the air.
For DPIs and soft mist inhalers, never use water. Wipe the inside and outside of the mouthpiece with a clean, dry cloth. Water will clump the powder or damage the mechanism.