How to Use an Inhaler Without a Spacer: A Step-by-Step Guide

If you have asthma or COPD, your inhaler is one of your most important tools. But an inhaler only helps if the medicine reaches your lungs. When technique is off, much of the dose can land in your mouth and throat instead.

This is more common than you might think. A 2019 meta-analysis of U.S. studies found that 86.7% of patients with obstructive lung disease made at least one error with their metered-dose inhaler. The good news is that these mistakes are easy to fix.

What Is a Metered-Dose Inhaler?

A metered-dose inhaler (MDI) is a small pressurized canister that releases a set amount of medicine as a fine spray. Many rescue inhalers and some daily controller inhalers are MDIs. You can use one with a spacer (a tube that attaches to the mouthpiece) or on its own.

Before You Start

• Check the dose counter. If it reads zero, the inhaler is empty and needs to be replaced (American Lung Association).
• Prime when needed. Prime a new inhaler, or one you haven’t used in 1 to 2 weeks or have dropped, by spraying it into the air as the package directs.

How to Use Your Inhaler: Step by Step

1. Shake the inhaler well and remove the cap.
2. Sit or stand up straight.
3. Breathe out all the way, away from the inhaler.
4. Position the inhaler. For the closed-mouth method, seal your lips tightly around the mouthpiece. For the open-mouth method, hold it 1½ to 2 inches in front of your open mouth (National Jewish Health). Use the method your provider recommends.
5. Press down once as you start breathing in.
6. Breathe in slowly and deeply for 3 to 5 seconds. A slow breath carries medicine deep into your airways.
7. Hold your breath for up to 10 seconds, then breathe out slowly.
8. Need a second puff? Shake the inhaler again and repeat the steps within about 1 minute.

After Each Use

If your inhaler contains a steroid, rinse your mouth with water and spit it out. This lowers the risk of thrush, a fungal infection in the mouth (Asthma and Allergy Foundation of America). Put the cap back on, and clean the plastic case and cap as the package directs.

The Most Common Inhaler Mistakes

The 2019 meta-analysis found these were the most frequent errors:

Mistake	How often it happened
Not breathing out fully before the puff	65.5%
Not holding breath for 5–10 seconds	41.9%
Breathing in too fast or not deeply	39.4%
Not breathing out after inhaling	35.9%
Not shaking the inhaler first	34.2%

If any of these sound familiar, you’re in good company, and now you know what to fix.

Should You Use a Spacer?

A spacer helps more medicine reach your airways and lungs instead of your mouth and throat. It can also make the inhaler easier to use and may reduce side effects (National Jewish Health). If you don’t have one, ask your provider whether a spacer is right for you.

Frequently Asked Questions

How long should I wait between puffs? Shake the inhaler again and take the second puff within about a minute, unless your provider gives you different instructions.

Why do I need to rinse my mouth? Steroid medicine left in your mouth can lead to thrush. Rinsing and spitting removes it.

How do I know when my inhaler is empty? Check the dose counter. When it reaches zero, replace the inhaler, even if it still sprays.

When to Call Your Provider

Call us if you need your rescue inhaler more often than usual, your symptoms aren’t well controlled, or you notice mouth soreness or white patches in your mouth.

Let Us Check Your Technique

At The Respire Institute, our pulmonary team treats asthma, COPD, and other lung conditions. We offer pulmonary function testing and pulmonary rehab. Bring your inhaler to your next visit, and we’ll make sure every puff counts.

Call 713-464-8099 or visit TheRespireInstitute.com to schedule a visit.