How to use puffers, inhalers, and other devices : Canadian Lung Association

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How to use puffers, inhalers, and other devices

Doctors usually treat asthma, COPD and other lung diseases with inhaled medicines – medicines you breathe in. These medicines come in different devices. Each kind of inhaled medicine device has its own set of instructions.

The poster shows colour photos of most of the asthma and COPD inhalers available in Canada (PDF)

It's very important that you know how to use your inhaled medicine, so you get the most from it. Ask your doctor, pharmacist or certified respiratory educator to show you how to use your medicine. Then, ask them to watch you take it, and tell you if you're doing it right.

Learn how to use these inhaled medicine devices:

How to use a puffer (also called an inhaler, metered-dose inhaler, or MDI)
How to use a a puffer with a spacing chamber (also called spacer or holding chamber)
How to use a Turbuhaler®
How to use a Diskus®
How to use a Diskhaler®
How to use a HandiHaler®®
How to use a Nebuliser

How to use a peak flow meter, a tool that measures how much air you can breathe out

How to clean your puffers and spacing chamber

How to use a puffer (also called a metered-dose inhaler, inhaler, or MDI)

Puffers spray a precise dose of medicine into your airways (breathing tubes). Puffers work best when you use them with a spacing chamber. A spacing chamber is a clear tube that helps the medicine go deep in your lungs, where you need it. If you use a puffer without a spacing chamber, some of the medicine will get stuck in your mouth and throat, and it won't reach your lungs.

Illustration of a puffer (metered-dose inhaler)

How to use a puffer (metered-dose inhaler) : if you don't have a spacing chamber

Stand up, or sit up with your back straight.
Remove the cap from the mouthpiece and shake the inhaler.
If you haven't used the puffer in 2 weeks or longer, or if you've dropped it: press the top of the cannister and spray it into the air. For rescue medications (bronchodiolators like Ventolin): spray 4 times. For other medicines, spray 2 times. This is called "priming" the inhaler. This step is to make sure you get a full dose of medicine. Do not spray the puffer near anyone's face.
Breathe out normally.
Put the mouthpeice between your teeth, over your tongue. Wrap your lips around the mouthpiece.
Take a slow deep breath in. As you're breathing in, press the cannister to spray a puff into your throat. Keep breathing in until your lungs are full. Now hold your breath for as long as you can, at least 10 seconds.
Breathe out normally.
If you need a second puff, wait one minute and repeat these steps.
Rinse your mouth out with water and spit the water out (don't swallow it). Rinsing your mouth can cut down on some side effects, like a white coating on your tongue (a yeast infection called thrush) or a sore throat.

How to use a puffer with a spacing chamber (also called a spacer or holding chamber)

A spacing chamber is a plastic tube that traps the spray from your puffer (inhaler). You spray your puffer into the spacing chamber, then slowly suck the air from the spacing chamber. Using a spacing chamber means you don't have to worry about breathing in and spraying your puffer at the exact same time. The spacing chamber helps the medicine get right down to your lungs. Your puffer medicine will work better if you use a spacing chamber.

Different companies make different models of spacing chambers. They all work in about the same way.

Ask your pharmacist or your local Lung Association about where to buy a spacing chamber.

How to use a spacing chamber without a mask

Remove the cap of the spacing chamber.
Remove the cap of the puffer. Shake the puffer up and down.
If you haven't used the puffer in 2 weeks or longer, or if you've dropped it: press the top of the cannister and spray it into the air. For rescue medicines (bronchodiolators like Ventolin): spray 4 times. For other medicines, spray 2 times. This is called "priming" the inhaler. This step is to make sure you get a full dose of medicine. Do not spray the puffer near anyone's face.
Insert the puffer in the hole at the back of the spacing chamber.
Sit up with your back straight, or stand up.
Blow all your breath out until your lungs are empty.
Seal your lips around the spacing chamber mouthpiece.
Press the down once on the puffer's cannister – this will spray medication into the spacing chamber.
Slowly suck the air from the spacing chamber. Breathe in until you can't take in any more breath.
Now hold your breath for as long as you can, at least 10 seconds.
Take the spacing chamber mouthpiece out of your mouth, and breathe out normally.
If you need a second puff, wait one minute and repeat these steps.
Do not spray more than one puff at a time into the spacing chamber.
Rinse your mouth out with water and spit the water out (don't swallow it). Rinsing your mouth can cut down on some side effects, like a white coating on your tongue (a yeast infection called thrush) or a sore throat.

How to use a puffer with a spacing chamber that has a mask

Doctors recommend spacing chambers with masks for children under five. They also recommend spacing chambers with masks for adults who can't keep their lips sealed around the regular spacing chamber.

Remove the cap of the puffer. Shake the puffer up and down.
If you haven't used the puffer in 2 weeks or longer, or if you've dropped it: press the top of the cannister and spray it into the air. For rescue medicines (bronchodiolators like Ventolin): spray 4 times. For other medicines, spray 2 times. This is called "priming" the inhaler. This step is to make sure you get a full dose of medicine. Do not spray the puffer near anyone's face.
Insert the puffer in the hole at the back of the spacing chamber.
Have the child stand up, or sit up with her back straight.
Put the mask over the child's mouth and nose. Press the mask against her face. Make sure there are no gaps between her face and the mask. Hold the mask on the child's face with one hand. With the other, hold the spacing chamber, with your finger on top of the puffer's cannister.
Press the puffer's cannister down to spray one puff into the spacing chamber.
Ask the child to breathe in and out through her mouth 6 times.
If your child needs more than one puff of medicine, repeat steps 5- 7. Do not spray more than one puff at a time into the spacing chamber.
Rinse your mouth out with water and spit the water out (don't swallow it). Rinsing your mouth can cut down on some side effects, like a white coating on your tongue (a yeast infection called thrush) or a sore throat.

Keep track of how many doses are left in your puffer (metered-dose inhaler)

To make sure you're getting the medicine you need, you need to keep track of how many times you've sprayed your puffer. It's the only way to know how many doses are left in your inhaler.

Some people try to shake the inhaler, float it in water, or taste it to see how much is left. None of these methods work. The only way to tell how many doses are left in the inhaler is to keep track of the doses you've taken by writing them down. You can tape a piece of masking tape to the outside of the inhaler, and mark a line every time you take a dose. Or you can keep a notebook and pen in a bag with your inhaler, and record each dose in the notebook.

Look at how many doses are in your inhaler. Subtract the doses you've taken from the total doses. Once you've taken all the doses in your inhaler, stop using it. You may still feel some liquid swishing around in the puffer, but it won't be medicine. Inhalers have two ingredients in them: your medicine, which helps you breathe, and a propellant, which is there to push the medicine out. If you have some liquid left in your inhaler after you've taken all the doses, it's just propellant. If you take a puff of propellant, it won't help your breathing. In fact, it may make your breathing worse.

How to use a Diskus® (dry powder inhaler)

A Diskus® is a plastic device containing powdered medication. A Diskus® is breath activated. This means when you inhale, the Diskus® automatically releases the medication. When inhaled correctly, the medication has a better chance to reach the small airways. This increases the medication's effectiveness.

How to use the Diskus®

Take the Diskus® out of the foil wrapper. Once the foil wrapper is opened the Diskus® must be used within two months.
Hold the Diskus® level with one hand.
Place the thumb of the other hand on the thumbgrip.
Push your thumb away from you until the Diskus® clicks. This will open the Diskus® so you can see the mouthpiece.
Hold the Diskus® level and slide the lever away from you until the Diskus® clicks. This will load the medication. Keep the Diskus® level so you don't loose the medication. Hold the Diskus® level and away from your mouth and gently breathe out. Never exhale into to Diskus®.
Seal your lips around the mouthpiece.
Inhale rapidly and deeply. Continue to take a full, deep breath.
Hold your breath for up to ten seconds. This allows the medication time to deposit in the airways.
Breathe normally.
Close the Diskus® by placing your thumb on the thumpgrip. Pull your thumb toward you until the discus clicks. The mouthpiece will be hidden and the lever will be reset.
Rinse your mouth out with water and spit the water out (don't swallow it). Rinsing your mouth can cut down on some side effects, like a white coating on your tongue (a yeast infection called thrush) or a sore throat.

How to tell when the Diskus® is empty

The Diskus® has a dose indicator on the top of the device. Numbers on the dose indicator shows how many doses are left in the diskus®.
When there are five doses left in the Diskus® the numbers on the dose indicator will turn red. This means the Diskus® is almost empty.
When the red number is at 0 the Diskus® is empty. Start using a new Diskus®.

How to care for your Diskus®:

Keep the Diskus® closed when not in use. Keep the diskus® dry. The Diskus® does not need to be cleaned routinely. If the mouthpiece is dirty, wipe it with a cloth.

How to use a Turbuhaler® (dry powder inhaler)

A Turbuhaler® is a plastic device containing dry powdered medication. A Turbuhaler® is breath-activated. This means when you inhale, the Turbuhaler® automatically releases the medication. If you use it properly, the Turbohaler can deliver medication deep into your lungs.

How to use a Turbuhaler®

Unscrew the cover and remove it.
Holding the Turbohaler upright, turn the coloured wheel one way and back the other way, until it clicks. It's now loaded with a new dose.
Breathe out normally.
Put the mouthpiece between your lips and tilt your head back slightly.
Breathe in deeply and forcefully.
Hold your breath for 10 seconds or as long as you can.
Remove the Turbuhaler from your mouth, and breathe out.
If a you need another dose, repeat the steps 3- 5.
If the medicine you are taking contains a corticosteroid, rinse your mouth out and gargle with water after you use it, then spit the water out. This helps prevent side effects like a yeast infection (thrush) in your mouth, and hoarseness in your throat.

How to tell when the Turbuhaler® is empty

The Turbuhaler® is empty and should be thrown out when the zero is in the centre of the dose-counting window.

How to clean your Turbuhaler®

Clean mouthpiece two or three times a week. Using a dry cloth, wipe away any particles which have collected on the mouthpiece. Never wash the mouthpiece. When a red mark and the number zero appears in the centre of the little window, the Turbuhaler® is empty.

Diskhaler® (dry powder inhaler)

Diskhaler® is a device you load with a small plastic disk. The disks contain several small pouches (blisters), each holding one dose of medication. Each time you need a dose, the Diskhaler® punctures (bursts) a pouch of the medication on the disk, so you can inhale it.

How to use a Diskhaler®

Remove the cover and check that the Diskhaler and mouthpiece are clean.
If a new medication disk is needed, pull the corners of the white cartridge out as far as it will go, then press the ridges on the sides inwards to remove the cartridge.
Place the new medication disk on the white rotating wheel, numbers facing up. Slide the cartridge all the way back in.
Pull the cartridge all the way out, then push it all the way in until you can see the highest number on the medication disk in the indicator window.
With the cartridge fully inserted, and the device kept flat, raise the lid as far as it goes, to pierce both sides of the medication blister.
Move the Diskhaler® away from your mouth and blow out all of your breath.
Place the mouthpiece between your teeth and lips, making sure you do not cover the air holes on the mouthpiece. Inhale as quickly and deeply as you can.
Take the Diskhaler® away from your mouth and holding your breath for about 10 seconds.
Breathe out slowly.
If you need another dose, pull the cartridge out all the way and then push it back in all the way. This will move the next blister into place. Repeat steps 5 through 9.
After you have finished using the Diskhaler®, put the cap back on.
If the medicine you are taking contains a corticosteroid, rinse your mouth out and gargle with water after you use it, then spit the water out. This helps prevent side effects like a yeast infection (thrush) in your mouth, and hoarseness in your throat.

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How to use a HandiHaler®

A HandiHaler® is an egg-shaped inhaler. It's mostly used for COPD medicine.

Remove a capsule from the blister package of medicine. Take the capsule out of the package right before you're going to use it.
Flip off the lid of the HandiHaler®.
Flip open the mouthpeice.
Put the capsule in the hole.
Flip the mouthpeice closed. Make sure you hear a click, so you know it's closed properly.
Hold the HandiHaler® upright, with the mouthpeice facing up.
Sit up with your back straight.
Press the big button on the side of the HandiHaler®. This pokes a hole in the capsule to let the medicine out.
Exhale: blow out all your air.
Seal your lips around the HandiHaler® mouthpeice.
Breathe in slowly and deeply from the HandiHaler® mouthpeice, until your lungs are full.
As you're breathing in, you should notice that the HandiHaler® is vibrating. This is supposed to happen. It shows that you're taking it properly.
Take the HandiHaler® out of your mouth and hold your breath for as long as you can (10 seconds or longer, if you can).
Breathe out normally.
Take another breath from the HandiHaler®, to make sure you get all the medicine: Seal your lips around the HandiHaler® and take another deep breath in.
Take the HandiHaler® out of your mouth.
Hold your breath for as long as you can (10 seconds or longer, if you can).
Breathe out normally.

Watch a video that shows how to use a HandiHaler®.

Nebuliser

Nebulisers are medical devices that deliver medicine as a vapour for people to inhale.

How to use a nebuliser

Find a location where you can sit comfortably for 10-15 minutes. Plug in the compressor.
It is very important to get specific written instructions if you are mixing your own nebulized treatments. Mix the medication as directed, or empty the prepared unit dose vials (UDVs) into the nebulizer. Do not mix different types of medications without permission from your doctor or pharmacist.
Assemble the mask or mouthpiece and connect the tubing from this to the port on the compressor.
Sit in an upright position, making sure you are comfortable. Put the mask over your nose and mouth (make sure it fits properly so the mist doesn't flow up into your eyes); OR, if you are using a mouthpiece, put it into your mouth.
Turn on the compressor.
Take slow, deep breaths. If possible, hold your breath for 10 seconds before slowly exhaling.
Continue until the medication chamber is empty.

How to clean your nebuliser and equipment

Wash the mask with hot, soapy water. Rinse well and allow to air dry before re-use.

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How to clean your puffers, spacers, and other inhaled medicine devices

How to clean your metered dose inhaler

To keep your puffer clean, keep the cap on the mouthpiece. Once a week,remove the medication canister from the plastic casing and wash the plastic casing in warm, soapy water. Rinse it in clear water. When the casing is dry, replace the medication canister in the casing and place the cap on the mouthpiece. Make sure the little hole at the back of the mouthpeice is clear. If it gets blocked up, you won't get your full dose of medicine.

How to clean your spacing chamber

To wash your spacing chamber, follow the instructions on the package.

Clean your spacing chamber before you use it for the first time, and once a week after that. Take it apart and wash the pieces in warm soapy water for 15 minutes. Rinse the spacing chmaber in clear water. Let it air dry on a paper towel or a clean dish towel. Make sure it's completely dry before you use it.

How to use a peak flow meter

Illustration of a Mini-Wright Peak flow meter

Peak flow meters measure how fast you can blow air from lungs (peak expiratory flow rate, also called PEFR or PEF). Peak flow meters give you a reading or "score". Your peak flow scores can help you and your doctor see if your asthma symptoms are getting better or worse.

Peak flow meters help you keep track of how your lungs are doing over time. The amount of air you can blow changes depending on how healthy your lungs are. If you have an asthma flare-up that makes your breathing tubes squeeze tgoether, you won't be able to blow out as much air as usual. This will make your peak flow score go down. If you have swollen airways from an allergic reaction, you won't be able to breathe out as much air as usual. This will also give you a lower peak flow score. You peak flow score shows how your lungs are working at a particular time.

Watch a video that shows how to use a peak flow meter.

How to use a peak flow meter

To use a peak flow meter, follow the instructions on the package. In general, these are the steps you can follow:

Stand up or sit up with a straight back.
Push the marker to zero.
Take a deep breath, seal your lips around the mouthpeice, and blow as hard and as fast as you can into the peak flow meter.
Write down the reading (your score).
Set the marker back to zero. Take your peak flow two more times. Note down your readings (your score).
Each time you test your peak flow, do three blows. The best of the three scores is your actual score. That's the score you should write down and show the doctor.

Doctors often ask people to take peak flow readings every day, and write down their peak flow scores. Sometimes people use an asthma diary card to record their readings. Taking your peak flow regularly can help you recognize changes in your airflow, and can help you catch asthme flare-ups before they get out of control.

You can buy a peak flow meter at your drugstore; they cost between $20.00 - $50.00.

Ask you doctor, certified respiratory educator, or pharmacist to show you how to use your peak flow meter. Ask them how to understand what your peak flow scores mean.

Use the same peak flow meter consistently; peak flow meters might take different readings, and using more than one device can confuse the results.

How to clean your peak flow meter

Dirt trapped in your peak flow meter can make the readings inaccurate. That's why it's important clean it regularly. Follow the manufactuer's instructions to clean your peak flow meter. In general, you should wash your peak flow meter in warm soapy water. Rinse it gently in clear water, then let it air dry. If you have a virus (cold, flu, etc), wash your peak flow meter after every use. Make sure your peak flow meter is completely dry before using it.

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