Poor inhaler technique is one of the commonest reasons asthma and COPD appear uncontrolled, and asking whether a patient uses the inhaler correctly does not detect it. Watching does.
For a pressurised metered-dose inhaler, the key steps are shaking, breathing out fully, a slow deep inhalation started just as the canister is pressed, and a breath-hold of up to 10 seconds. A spacer removes the need to coordinate and is the right choice for most patients using one. For dry-powder inhalers, the inhalation must be fast and forceful, which frail or breathless patients may not manage.
Check technique at every review and before any step-up in treatment, and match the device to what the patient can actually do.
- Ask the patient to demonstrate the inhaler at every review
- Offer a spacer with metered-dose inhalers, especially for children and older adults
- Choose a device the patient can use, not just the cheapest or newest
- Check technique and adherence before stepping up treatment
Why it matters
Correcting technique is cheaper and safer than adding another drug.
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