Your Reading List

Guide Health: All inhalers are not equal

Inhalers are great tools for delivering your medication just where it’s needed, but they must be used correctly, which too few people do

Inhaled medication has long been used to treat a variety of lung conditions.

It makes sense that inhalers are used to control the symptoms of asthma, bronchitis and emphysema because inhalers deliver their medication right into the lungs where the breathing problems occur.

Inhaled medication has long been used to alleviate various lung conditions, but the first actual inhaler was introduced in 1982. It was the familiar blue “boot” inhaler for salbutamol, which is still used today.

The “boot” inhalers use a propellant to deliver medication directly to lung tissues. At one time the propellant was chlorofluorocarbon or CFC, but today the more environment-friendly hydrofluoroalkane or HFA is used.

By compressing the pressurized canister in the “boot,” medication is pushed from delivery system through the mouth and into the lungs.

These inhalers are easy to use, but do require both good technique and manual dexterity. 

HFA or metered-dose inhalers need to be aimed into the mouth with the compression of the canister being co-ordinated at the same time as a big inhalation. The medication should end up in the lungs and not remain in the mouth.

With weak hands or even arthritic ones, co-ordination can be difficult. Using a spacer device will help when co-ordination is not possible.

The inhaler is attached to one end of the spacer device with the other end held in the mouth. Then, the inhaler is compressed for one dose or puff of medication. The medication is held in the spacer device and it can be breathed in with normal breathing

Instead of propellants, other inhalers called breath-activated inhalers, use normal breaths to inhale the medication. The medication is either a dry powder or a liquid (which leads to the terms, dry-powder inhalers and soft-mist inhalers). The mouthpiece of the inhaler is placed in the mouth and with an in-breath, the medication is drawn into the lungs.

There are usually dose counters that track the loading of a dose and the number of doses left in the inhaler.

A wide variety of breath-activated inhalers are available, and if there is doubt as to technique, the Lung Association of Canada has a complete listing along with videos of how to use them.

Besides different mechanisms of delivery, inhalers contain different types of medication. In general terms, there are medications that are used on a regular basis to control symptoms, that is “controllers,” and ones that are used on an as-needed basis when breathing symptoms flare, that is “rescue inhalers.” It is important to use controllers routinely, even if there are few symptoms, because then the rescue inhalers may not be needed as often.

Technique is very important with inhaler use. Some studies show that only two-thirds of people use breath-activated inhalers correctly. With metered-dose inhalers, the correct usage drops to less than a third.

From time to time, technique should be checked in case any bad habits have developed, and many inhaler manufacturers have web sites with step by step instructions. It doesn’t make sense to have an inhaler and not use it correctly.

About the author


Marie Berry is a lawyer/pharmacist interested in health and education.



Stories from our other publications