Proper Inhaler Use: How to Help Control Asthma and COPD

The over-the-counter option is inhaled epinephrine, which Parenti does not recommend because of potential side effects. There are also nebulizers, which generate an aerosol that’s inhaled. These stationary units, which require electricity or a battery, are not as convenient as handheld, mobile inhalers.

Meter-dose or pump inhalers blow out an aerosol into the lungs using a pumping mechanism—triggered by a finger—and dry-powder inhalers work by drawing powder into the lungs.

Both. The two main types of handheld inhalers are those used for rescue during an emergency. These contain bronchodilators, which immediately open up the airways to provide relief. Other inhalers act as a control medication that contains anti-inflammatory drugs. These don’t provide immediate relief from an acute attack but can be used longer term to keep inflammation down over time.

Some people use a combination of these two inhaler types. For example, someone with persistent asthma may use a long-term control inhaler one or two times a day and a second inhaler as needed as a rescue device (a common dosage is two puffs every six hours as symptoms persist). A goal, Parenti said, is to treat the asthma well enough that patients don’t need to use the rescue inhaler at all. “The long-term control treats the illness,” Parenti said. “The rescue therapy treats the symptoms of the illness.”

Inhalers are primarily prescribed to alleviate symptoms related to asthma, which can be triggered by allergies, viruses, or smoking or vaping. Symptoms can include cough, wheezing and chest tightness. Asthma can develop early in life (shortly after birth) and get better with age or persist throughout a lifetime, while other people may develop symptoms later in life. In short: symptoms vary widely.

COPD, however, typically occurs in the mid-50s or early 60s and is usually progressive over time. COPD can be triggered by tobacco use, exposure to chronic irritants, such as chemicals or dust, or it can develop from uncontrolled asthma. In addition to inhalers, quitting smoking or vaping is a primary intervention for COPD.

One inhaler holds about a month of medicine in it, Parenti said. Rescue inhalers may last more than a month if used sparingly.

Parenti encourages patients to know the name, dose and frequency of the medicine they’re taking and to follow dosage directions to ensure they’re taking their medication the right number of times a day. It’s also important to know at least an estimate of how many doses you have left. “You don’t want to let it be Friday night, you run out and you can’t get ahold of your doctor,” he said.

For pump inhalers, you should sit up straight, head forward, and empty the lungs with a big exhale. With the inhaler in your mouth, apply enough pressure for it to squirt into your mouth. As the medicine squirts out, inhale at that moment to catch the flow and bring it down into the lungs (instead of swallowing it). Breathe all the way in, hold your breath for about 10 seconds, if possible, and blow out. This process is typically repeated a second time after about a minute break.

If your inhaler doesn’t seem to be working for you, have your doctor or pharmacist check that you’re using the device correctly. Online tutorials, such as YouTube videos, can also be instructive, Parenti said.

Powder-based inhalers use an inhale of breath to get the medication into the lungs but, unlike pump inhalers, don’t require hand-eye coordination involved in squeezing down a pump. Dry-powder inhalers are typically used once or twice a day, which is less frequent than a pump inhaler. Because they are simpler and less frequently needed, compliance may increase. Dry-powder inhalers could also be easier to use for arthritic patients, who may have a harder time squeezing pump inhalers. The downside: you need decent lung capacity to draw the medicine into your lungs on your own, instead of it being accelerated with a squirt, like with a pump inhaler.

“Don’t smoke, don’t vape, and avoid people who smoke and vape close to you—don’t go into any smoky environments,” Parenti said. “And avoid other irritant exposures. For example, if work is being done in your house and there’s dust in the air, try to stay away. Take your medicines regularly. If you seem to be doing everything right but noticing more symptoms, that’s when you contact your doctor.”