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COPD: How to Use Inhalers

What is COPD?

COPD is a condition that affects the lungs and airways. COPD stands for chronic (KRON-ick) obstructive (ob-STRUCK-tiv) pulmonary (PULL-muh-nair-ee) disease. Chronic means the condition is long term. You will have it the rest of your life. COPD usually gets worse over time, but you can learn how to manage it. Pulmonary refers to the lungs and airways. The condition is obstructive because it limits the flow of air into and out of your lungs.

For an overview of COPD, see the UPMC patient education page COPD: Chronic Obstructive Pulmonary Disease.

Inhaled medicines

Inhaling is often the best way to take medicine for COPD. Inhaled medicines go directly to the airways and cause fewer side effects. There are several types of inhalers. Some common ones are the metered-dose inhaler (MDI), the Aerolizer inhaler, and the dry-powder inhalers (Diskus and Turbuhaler). The metered-dose inhaler has been available for years. The dry-powder inhaler and the Aerolizer are newer.

This page does not tell you about all the devices available to inhale medicine. New devices are coming on the market. It is very important to learn the correct way to use your inhaling device. For devices not in page, be sure you get detailed instructions. Read the package insert, which may have printed instructions with diagrams. Also ask your health care team to watch how you use the inhaling device.

Metered-dose inhalers

There are 3 different methods for using metered-dose inhalers (MDIs):

• open-mouth method
• closed-mouth method
• spacer method

The spacer method is often preferred. A spacer deposits less medicine in your mouth and the back of your throat. With a spacer, you can inhale more medicine directly into your lungs, where you need it. The next preferred method is the open-mouth method. When mastered, it leaves less medicine in your mouth and throat and more in your lungs. It’s important to become very familiar with the method you use. This will ensure that you get the most benefit from your medicine.

Open-Mouth Method

Follow these steps:

1. Remove the cap. Hold the inhaler upright.
2. Check to be sure the mouth piece is free of any foreign object (such as a coin).
3. Shake the inhaler.
4. Tilt your head back slightly. Breathe out slowly.
5. Place the inhaler 1 to 2 inches in front of your open mouth (the width of 2 fingers).
6. Press down on the canister firmly as you start to breathe in slowly. (Press down until the medicine is released.)
7. Breathe in slowly for a count of 3 to 5 seconds.
8.  Hold your breath for a slow count to 10 (10 seconds). 
9. If more puffs are prescribed, the ideal is to wait between doses. This will make the medicine more effective.
   • For bronchodilators that are short-acting beta agonists, it is best to wait 10 minutes between doses. But you may find it more practical to wait 3 to 5 minutes. These fast-acting inhalers begin to open your airways quickly. When you wait after your first dose, the next doses can go deeper into your lungs. See “How to Sequence Inhalers”.
   • For other inhalers, try to wait 1 minute between puffs.
10.  Rinse and gargle with mouth wash or with water after using any steroid inhaler (even when it’s combined with another medicine).
    

Note: If you carry your inhaler in a purse or pocket, make sure the cap stays secured. Ifthe cap comes off, be sure to check the mouth piece for foreign objects (such as a coin) before you use the inhaler.

Closed-Mouth Method

Note: This method is not preferred over the spacer or open-mouth methods. Less medicine reaches your airways with the closed-mouth method. Follow these steps:

1. Remove the cap. Hold the inhaler upright.
2. Check to be sure the mouth piece is free of any foreign object (such as a coin).
3. Shake the inhaler.
4. Tilt your head back slightly. Breathe out slowly.
5. Place the inhaler in your mouth. Close your mouth.
6. Press down on the canister firmly as you start to breathe in slowly. (Press down until the medicine is released.)
7. Breathe in slowly for a count of 3 to 5seconds.
8. Hold your breath for a slow count to 10 (10 seconds).
9. If more puffs are prescribed, the ideal is to wait between doses.
   • For bronchodilators that are short-acting beta agonists, it is best to wait 10 minutes between doses. But you may find it more practical to wait 3 to 5 minutes. These fast-acting inhalers begin to open your airways quickly. When you wait after your first dose, the next doses can go deeper into your lungs. See “How to Sequence Inhalers” .
   • For other inhalers, try to wait 1 minute between puffs. 
10. Rinse and gargle with mouth wash or with water after using any steroid inhaler (even when it’s combined with another medicine).

Note: If you carry your inhaler in your purse or pocket, make sure the cap stays secured. If the cap comes off, be sure to check the mouth piece for foreign objects (such as a coin) before you use the inhaler.

Spacer Method

Spacer devices offer several benefits. When you use a spacer, more medicine reaches your lungs, where you need it. Less medicine isdeposited on your tongue and the back of your mouth. Side effects also are fewer and milder. For example, you will have less hoarseness and fewer mouth and throat reactions. If it’s hard for you to compress the canister and inhale at the same time, your medicine dose may be more effective when you use a spacer.

There are several types of spacers available. It’s important that you follow the instructions on the package insert for your particular spacer. Follow these steps:

1. Remove the caps. Check to be sure theinhaler and spacer are free of any foreign object (such as a coin).
2. Attach the inhaler to the spacer.
3. Shake well.
4. Tilt your head back slightly. Sit upright, and breathe out normally.
5. Place the mouth piece into your mouth. Close your lips around it.
6. Press down on the canister firmly until the medicine is released. This will put 1 puff of the medicine into the spacer.
7. Breathe in slowly for a count of 3 to 5seconds. Many spacers whistle if you inhale too fast.
8. Hold your breath for a slow count to 10 (10 seconds).
9. Remove the spacer from your mouth, and then breathe out slowly.
10. If more puffs are prescribed, the ideal is to wait between doses. This will make the medicine more effective.
    • For bronchodilators that are short-acting beta agonists, it is best to wait 10 minutes between doses. But you may find it more practical to wait 3 to 5 minutes. These fast-acting inhalers begin to open your airways quickly. When you wait after your first dose, the next doses can go deeper into your lungs. See “How to Sequence Inhalers".
    • For other inhalers, try to wait 1 minute between puffs. 
11.  Rinse and gargle with mouth wash or with water after using any steroid inhaler (even when it’s combined with another medicine).

Note: If you carry your inhaler and spacer in your purse or pocket, make sure the caps stay secured. If the cap comes off, be sure that the inhaler and spacer are free of foreign objects (such as a coin) before use.

Doses Left

You can use the math method below to find out how much medicine is left in your MDI.

Number of days. To find out the number of days that you can use a new MDI, follow the steps below.

Step 1: Each inhaler is marked with the number of doses it contains. Find the number of doses marked on your inhaler. Example: 200 doses (or puffs)

Step 2: Add up the number of puffs you use each day. Example: 2 puffs in the morning plus 2 puffs in the evening = 4 puffs per day

Step 3: Take the number of doses (puffs) marked on your new inhaler. Divide it by the number of puffs you use each day. Example: 200 doses (puffs) divided by 4 puffs = 50 days of use

Take the number of days of use in your new inhaler. On your calendar, count that number of days ahead from the first day you will use the inhaler. Mark the date on your calendar that shows when the inhaler will be empty. Refill your inhaler prescription a day or two before the target empty date. Also, write the target empty date on the canister with an indelible marker.

Number of doses. To find out the number of doses left in your MDI, follow the steps below.

Step 1: Count the number of puffs you have used from one inhaler for a certain number of days. Example: 4 puffs per day times 40 days =160 puffs used

Step 2: Subtract the number of puffs used from the total doses (puffs) marked on the inhaler. Example: 200 doses (puffs) minus 160 puffs used = 40 puffs left

Step 3: Divide the number of puffs left by the number of puffs you will use each day. Example: 40 puffs left divided by 4 puffs per day = 10 days of use left

The math method works only if you take a set number of puffs every day from your inhaler. If you use your inhaler “as needed,” this method does not work.

Note: There is a device on the market that attaches to your canister and counts the number of doses used.

MDI Care

Metered-dose inhalers. Rinse the mouth piece (plastic housing) and cap daily in warm running water. Wash the mouth piece and cap in mild soap and rinse in warm water at least 2 times a week, and more often if you have an infection. The mouth piece and cap must be dry before you use the inhaler again. While the cleaned inhaler is drying, you must use another inhaler.

Spacers. Clean your spacer well. Follow the instructions on the package insert for your specific spacer.

Dry-powder inhaler

The Diskus is a dry-powder inhaler.

How to Use the Diskus Inhaler

Follow these steps:

1. Hold the Diskus with one hand.
2. Place your thumb on the thumb grip. Then push it as far away from you as it will go. You will now see the mouth piece.
3. Slide the “trigger” away from you until you hear it click. Your dose is now ready to be inhaled.
4. Bring the Diskus opening up to your mouth. Be careful not to tilt the Diskus.It must stay in a level position until after you inhale the medicine.
5. Place the Diskus opening up to your mouth. Take in a slow, deep breath. As you breathe in, count to 5. This allows you to breathe all the medicine into your airways.
6. Hold your breath for up to 10 seconds. Move the Diskus away from your mouth.
7. Breathe out slowly.
8. Close the Diskus by sliding the thumb grip back over the mouth piece.
9. Rinse and gargle with diluted mouth wash, or just with water if you’re not able to use mouth wash. This helps prevent hoarseness and an infection in your mouth from the inhaled steroids.
10. Never wash the Diskus after use.
    

Doses Left

A counter on top of the Diskus shows how many doses are left. Each time you click the trigger, 1 dose is released, and the counterreduces by 1.

Diskus Care

Do not wash Diskus inhalers after use. You may wipe them with a clean, damp cloth to remove any residue. The Diskus must always be kept dry.

How to sequence inhalers

Many people use several inhalers at a time. You may wonder which inhaler you should use first. Keep in mind that bronchodilators work faster than inhaled steroids. Use bronchodilators first because these fast-acting inhalers open your airways quickly. Use the inhaled steroids last, so then they can go deeper into your lungs.

The general rules are:

• First, use your fastest-acting bronchodilator, for example, albuterol.
• Next, use any other bronchodilators prescribed for your regular use, for example, Atrovent.
• Last, use your steroid inhaler.

Gargling

It’s very important that you rinse and gargle after you use inhaled steroids. Rinse and gargle with mouth wash or just water after using any steroid inhaler (even when it’s combined with another medicine). This will prevent unwanted side effects that may occur with inhaled steroid use. One of these side effects is called oral thrush. If your mouth or tongue become sore or reddened, call your doctor. You may need special medicine to treat this condition.

When should you seek help?

If any of the following happen to you, take steps to get medical care:

• Your mucus changes in color, consistency, or amount.
• Your wheeze, cough, or shortness of breath gets worse, even after you take your medicine and it has time to work.
• Your breathing gets difficult.
• You have trouble walking or talking.

Call 911 right away if any of the following occur:

• You get confused.
• You have trouble staying awake.
• Your lips or fingernails are blue or gray.

If you have questions

If you have any questions, call your doctor or nurse at _________________________.