Poor inhaler technique is one of the commonest reasons asthma and COPD appear uncontrolled. Errors include not exhaling first, poor coordination with a pressurised inhaler, inhaling too gently through a dry-powder device, and not holding the breath afterwards.
Asking whether the patient uses the inhaler correctly is not enough; watch them do it with their own device. Correcting technique, adding a spacer to a pressurised inhaler, or switching to a device the patient can use often controls symptoms without adding a drug.
- Ask the patient to demonstrate their own inhaler at every review.
- Check exhalation before, the inhalation speed suited to the device, and a breath-hold after.
- Add a spacer for pressurised metered-dose inhalers where coordination is poor.
- Choose a device the patient can actually use, especially in older adults.
- Check adherence and refill history alongside technique.
Why it matters
A step-up for a technique problem adds cost and side effects without improving control.
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