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How to Use Your Inhaler Correctly | Step-by-Step Guide | Chhajed Lung Care
Patient Education · Airway & Breathing Devices

How to use your inhaler — the correct technique, device by device

Most inhalers fail not because the medicine is wrong, but because the technique is. This guide walks through the correct steps for every device commonly prescribed in India — with illustrations, common mistakes, and quick answers — reviewed by Dr. Prashant N. Chhajed, Pulmonologist & Sleep Medicine Specialist.

Why technique matters: Studies show that up to 70–90% of patients make at least one critical error when using their inhaler. A perfectly prescribed medicine delivered incorrectly means the drug never reaches the airway where it is needed. Ten minutes spent learning the correct steps below can matter more than any change in your prescription.
A

Metered-Dose Inhaler (MDI) with Spacer

Also called: puff inhaler, aerosol inhaler, "pump"
  1. Remove the cap and shake the inhaler vigorously 4–5 times.
  2. Insert the mouthpiece of the MDI into the wide end of the spacer.
  3. Sit or stand upright. Breathe out fully, away from the spacer.
  4. Place the spacer mouthpiece in your mouth and close your lips around it to form a tight seal (or fit the mask snugly over nose and mouth).
  5. Press the canister down once to release one puff into the spacer.
  6. Breathe in slowly and deeply through the mouth over 4–5 seconds. A single slow breath is preferred; if that is difficult, take 5 normal tidal breaths through the spacer instead.
  7. Hold your breath for 5–10 seconds, then breathe out slowly through the nose.
  8. If a second puff is prescribed, wait 30–60 seconds and repeat from step 3.
  9. If the medicine is a steroid (orange/brown/purple inhalers), rinse your mouth with water and spit it out afterward.

Common mistakes

  • Pressing the canister more than once into the spacer before inhaling
  • Breathing in too fast (this deposits the drug in the throat, not the lungs)
  • Not shaking the inhaler before use
  • Using a spacer with a hole, crack, or missing valve

Care of the spacer

  • Wash weekly in mild soapy water; air-dry without wiping the inside (wiping causes static that reduces drug delivery)
  • Replace the spacer if the valve becomes stiff or torn
B

Revolizer & Rotacap (Rotahaler-type devices)

Dry powder inhaler, capsule-based · loaded with a Rotacap before each dose
  1. Remove the cap and hold the device upright.
  2. Open the mouthpiece/loading chamber and place the Rotacap into the round chamber (Rotahaler) or capsule slot (Revolizer).
  3. Rotahaler: twist the body of the device fully in one direction to pierce the capsule. Revolizer: close the lid until it clicks, which pierces the capsule automatically.
  4. Turn your head away from the device and breathe out fully — never breathe out into the device, as this can blow the powder away.
  5. Seal your lips tightly around the mouthpiece.
  6. Breathe in quickly and as forcefully and deeply as you can in a single breath (unlike the MDI, DPIs need a fast, deep inhalation to disperse the powder).
  7. Hold your breath for 5–10 seconds before breathing out away from the device.
  8. Open the device and check that the capsule is empty; if powder remains, repeat the inhalation.
  9. Discard the empty capsule and close the device.

Common mistakes

  • Breathing in too gently — DPIs are only effective with a fast, forceful inhalation
  • Loading two capsules at once
  • Exhaling into the mouthpiece before inhaling
  • Not checking whether the capsule has emptied fully

Who should be cautious

  • Young children and patients with very weak inspiratory effort (e.g. severe COPD, frailty) may not generate enough airflow — an MDI with spacer may suit them better
C

Lupihaler & Transcaps

Capsule-based dry powder inhaler system (Lupin)
  1. Hold the Lupihaler upright and twist to open the mouthpiece cover.
  2. Place one Transcap into the capsule chamber — do not load it into the mouthpiece itself.
  3. Close the device firmly until you hear/feel a click; this pierces the capsule.
  4. Breathe out fully, away from the device.
  5. Close your lips firmly around the mouthpiece, keeping the device level.
  6. Inhale forcefully and deeply in one continuous breath so the capsule spins and releases the powder (you may hear a whirring/rattling sound — this confirms the capsule is spinning correctly).
  7. Hold your breath for 5–10 seconds, then exhale away from the device.
  8. Open and check the Transcap is empty; repeat the inhalation once if powder remains.
  9. Discard the used capsule; never reuse a Transcap.

Common mistakes

  • Not hearing/feeling the capsule vibrate — usually means inhalation was too weak or the capsule was loaded incorrectly
  • Storing Transcaps outside their foil strip, which exposes them to moisture and reduces potency
  • Loading a capsule that is already punctured or empty

Storage tip

  • Keep Transcaps in the blister strip until the moment of use; humidity is the most common reason for a "no rattle, no effect" dose
D

Syncrohaler (Breath-Actuated Inhaler)

Also written "Synchrobreathe" · fires automatically when you inhale — no hand-lung coordination needed
  1. Remove the cap and shake the device 4–5 times.
  2. Hold the inhaler upright and, if present, cock the lever/mechanism as directed on the pack (some models arm automatically on opening the cap).
  3. Breathe out fully, away from the device.
  4. Place the mouthpiece between your teeth and seal your lips around it — do not block the air vents with your fingers.
  5. Begin breathing in slowly and steadily; the device will release the dose automatically once your inspiratory flow crosses its trigger threshold — you may feel or hear a soft click or puff.
  6. Continue to breathe in fully and deeply after the dose fires.
  7. Hold your breath for 5–10 seconds, then breathe out slowly.
  8. Close the cap; this typically re-arms the device for the next dose.

Common mistakes

  • Stopping the inhalation the moment the click/puff is felt, instead of continuing to breathe in fully
  • Covering the air vents with fingers or lips
  • Breathing in too fast, which can startle patients and cut the breath short before full dose delivery

Best suited for

  • Patients who struggle to press-and-breathe in sync with a standard MDI, particularly elderly patients with arthritis or coordination difficulty
E

Turbuhaler

Multi-dose dry powder inhaler with a twist-loading base
  1. Unscrew and lift off the white cover.
  2. Hold the Turbuhaler upright (this is essential — the dose will not load correctly if tilted).
  3. Twist the coloured grip fully in one direction, then fully back the other way, until you hear a distinct "click." This loads one dose.
  4. Breathe out fully, away from the mouthpiece.
  5. Place the mouthpiece between your teeth and close your lips around it.
  6. Inhale forcefully and deeply — the Turbuhaler requires a strong, fast breath, as the dose is very fine and has no taste or visible cloud, so you will not feel or see it being delivered.
  7. Remove the inhaler from your mouth before breathing out.
  8. Hold your breath for 5–10 seconds, then exhale slowly.
  9. Replace the cover after use.

Common mistakes

  • Loading the device while lying down or tilted
  • Twisting the base more than once per dose (wastes medication)
  • Assuming the device "isn't working" because no taste or mist is felt — this is normal for the Turbuhaler
  • Breathing out into the mouthpiece after loading, which disperses the dose

Dose counter

  • A red mark appears on the window when 20 doses remain — plan your refill at this point
F

Ellipta

Slide-cover multi-dose dry powder inhaler
  1. Slide the cover down until you hear a click. This loads the dose — do not shake the device, and do not press it more than once per dose.
  2. Do not cover the small air vent on top of the device while holding it.
  3. Breathe out fully, away from the inhaler.
  4. Place the mouthpiece between your lips and form a tight seal.
  5. Take one long, steady, deep breath in through the mouth — you may not taste or feel the dose, which is normal.
  6. Remove the inhaler from your mouth and hold your breath for 3–4 seconds (or as long as comfortable).
  7. Breathe out slowly, away from the device.
  8. Slide the cover back up to close it fully — this protects the next dose until you are ready to use it.

Common mistakes

  • Opening and closing the cover repeatedly out of curiosity — each open-close cycle wastes one dose
  • Blocking the air vent with a finger
  • Biting or chewing the mouthpiece

Dose counter

  • Counts down with every dose; when it shows "0," the device is empty even if it still slides open
G

Jet Nebuliser

Compressor-driven nebuliser, used for acute attacks and for patients who cannot use handheld inhalers
  1. Wash your hands before assembling the device.
  2. Pour the prescribed medication (and diluent/saline, if instructed) into the nebuliser cup — do not mix medications unless your doctor has specifically approved the combination.
  3. Assemble the cup, connect it to the mouthpiece or mask, and connect the tubing to the compressor.
  4. Sit upright in a comfortable chair; switch on the compressor and check that a visible mist is produced.
  5. Place the mouthpiece between your lips (preferred over a mask, as it delivers more drug to the lungs) or fit the mask snugly over your nose and mouth.
  6. Breathe normally and calmly through the mouth — occasional deeper breaths help, but forced deep breathing is not required.
  7. Continue until the medication is fully nebulised, usually 8–15 minutes, or until misting sputters and stops.
  8. Gently tap the cup near the end to release any remaining droplets on the sides.
  9. Switch off the compressor, disassemble, wash all parts (except tubing) in warm soapy water, rinse and air-dry completely before the next use.

Common mistakes

  • Lying flat while nebulising, which reduces drug deposition in the lungs
  • Reusing unwashed nebuliser cups, which risks bacterial contamination
  • Talking through the mouthpiece during the session, which lets mist escape

Best suited for

  • Acute breathlessness, young children, and patients unable to generate the inspiratory effort needed for MDIs or DPIs
H

Ultrasonic Nebulisation

Uses high-frequency vibration of a piezoelectric crystal to generate mist
  1. Check that the medication prescribed is compatible with ultrasonic nebulisation — see note alongside.
  2. Pour the medication into the ultrasonic nebuliser's medication chamber, ensuring the crystal/diaphragm area is covered as per the device manual.
  3. Attach the mouthpiece or mask and switch the device on.
  4. Sit upright and breathe normally through the mouthpiece, in the same way as with a jet nebuliser.
  5. Continue until the chamber is empty or misting stops, typically faster than a jet nebuliser (around 5–10 minutes).
  6. Switch off, disassemble, and clean the chamber and mouthpiece as per the manufacturer's instructions; the crystal surface should be wiped gently, never scrubbed.

Important limitation

  • Ultrasonic nebulisers are not suitable for suspensions (e.g. budesonide) or thick/viscous solutions, as the ultrasonic energy can generate heat that degrades certain drug particles and does not aerosolise suspended particles efficiently
  • Best used for clear solutions such as saline or bronchodilator solutions specifically approved for ultrasonic use — always check with your pharmacist or doctor before use

Advantages

  • Quieter than jet nebulisers and generally faster
I

Mesh Nebulisation

Vibrating-mesh technology · compact, battery-operated, portable
  1. Charge or fit batteries in the device before starting, if it is battery-operated.
  2. Open the medication chamber and pour in the prescribed dose, avoiding spillage on the mesh membrane.
  3. Close the chamber securely and attach the mouthpiece or mask.
  4. Switch the device on; a fine, near-silent mist should appear within seconds.
  5. Sit upright and breathe normally through the mouthpiece.
  6. Continue until the chamber empties — mesh nebulisers are typically faster and produce less residual (wasted) medication than jet or ultrasonic types.
  7. Switch off and clean the mesh gently as instructed by the manufacturer — the mesh has micro-perforations that can clog if left uncleaned or rinsed incorrectly.
  8. Air-dry with the chamber open before storing.

Common mistakes

  • Not cleaning the mesh immediately after use, allowing medication residue to dry and block the micro-holes
  • Using thick suspensions not approved for the specific mesh model, which can clog the membrane
  • Tilting the device beyond the angle specified in the manual, which can cause leakage

Advantages

  • Silent, portable, and suitable for travel; gentle enough for infants and elderly patients; can handle most solutions and some suspensions depending on the model

Not sure your technique is correct?

Book a 10-minute inhaler technique check at Chhajed Lung Care Clinic, Santacruz West.

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