Asthma

Table of contents
Medically reviewed by
Dr Daniel Atkinson
GP Clinical Lead
on August 02, 2022.
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How do puffers work?

Puffers deliver medications that are breathed into the lungs via the mouth. These medications work by opening the airway more fully or reducing inflammation, enabling more air to move in and out of the lungs.

While inhalers are most often used by people with asthma, they can also be prescribed for patients with bronchitis, COPD, a persistent cough or other respiratory illness.

There are different types of inhalers, and how an asthma inhaler works will depend on the variety you are using. Some puffers have medicine in a pressurised cylinder (like an aerosol), some have a fine mist or powder.

Metered Dose Inhalers (MDI) are the most common type; you activate the inhaler by pressing the cylinder and taking a deep breath inwards at the same time. Breath activated inhalers don’t require you to breathe in and press at the same time, they work (you guessed it) as soon as you take a deep breath in. Breath activated inhalers can deliver a fine mist of medication or a dry powder. Both work really well. The medication is delivered to the surface of the airways of the lungs where it can reduce inflammation or work on airway muscles to help them open up.

Used correctly, the right puffer can:

  • Reduce your risk of an asthma attack
  • Help you to feel less breathless when doing physical activity
  • Enable you to cope better with your usual asthma triggers
  • Support you in getting better quality sleep
  • Reduce the time you take off of work due to your asthma

How to use an asthma puffer

If you have been prescribed a puffer for the first time, you almost certainly need to learn how to properly use it. While all inhalers require you to breathe in the medication, the exact technique you should use in order to do this will vary depending on the type of inhaler you are using. Here’s what you need to know to use your inhaler properly and effectively.

How to use a pMDI inhaler

The pMDI inhaler is the standard inhaler recommended for patients with asthma. It’s also commonly referred to as a ‘puffer’. Using a pMDI inhaler is very simple.

  1. Remove the cap from the mouthpiece (you may need to squeeze the sides of the cap to release it)
  2. Check the dose counter (if applicable)
  3. Hold the inhaler upright and shake it well
  4. Gently exhale to empty your lungs
  5. Place the mouthpiece between your teeth and close your lips to form a tight seal. Do not bite down on the mouthpiece
  6. Start to breathe in slowly through your mouth while simultaneously pressing down firmly on the canister
  7. Continue to breath in slowly and deeply for the remainder of the breath
  8. Hold your breath for around 5 seconds, or as long as feels comfortable
  9. Remove the inhaler and then gentle and slowly exhale
  10. If an additional dose is needed, repeat the steps listed above and then replace the cap

How to use an Accuhaler

An Accuhaler may look quite different to a pMDI inhaler but using it should still be simple to do.

  1. Hold the Accuhaler with one hand, placing the thumb of your other hand on the thumb grip. Push it around until it clicks to open the inhaler
  2. Check the dose counter to make sure you have medication available
  3. Slide the lever down until it clicks to load the medication
  4. Exhale gently (away from the mouthpiece)
  5. Place your mouth over the mouthpiece and take a deep, slow and steady breath through your mouth (not your nose)
  6. Remove the Accuhaler and hold your breath for 10 seconds
  7. Close the Accuhaler by placing your thumb into the grip and sliding it back around until the cover clicks back into place
  8. If an additional dose is required repeat steps as necessary

How to use a Turbuhaler

A turbuhaler works a little differently to a pMDI or accuhaler, but is very easy to use once you know how.

Unscrew the turbuhaler’s cap anticlockwise and take it off.
Holding the turbuhaler upright, twist its coloured base to the right as far as it goes.
Then, turn it back to the left until you hear a click - this means your dose is loaded.
Breathe out away from the turbuhaler before placing the mouthpiece into your mouth. Make sure you’re not covering any of the air inlets, and you’ve made a good seal with your lips.
Breathe in quickly and deeply through the turbuhaler as far as is comfortable.
Hold your breath for 5-10 seconds.
Remove the turbuhaler from your mouth and breathe out.
If you need to take another puff, repeat steps two to seven.
Replace the turbuhaler’s cap and screw it shut.

How to use an Autohaler

An Autohaler is breath-activated, meaning you don’t need to rely on hand-breath coordination to successfully administer the treatment.

  1. Remove the cover from the mouthpiece
  2. Shake your Autohaler well
  3. Holding the inhaler upright, push the lever up until it clicks into place
  4. Exhale away from the inhaler and then place the mouthpiece into your mouth and seal your lips firmly around it
  5. Breathe in slowly and deeply, filling your lungs. The Autohaler will release the medication automatically
  6. With the Autohaler still in your mouth, hold your breath for 10 seconds
  7. Remove the Autohaler and exhale fully
  8. Press the lever down and replace the cap over the mouthpiece
  9. If a further dose is required, repeat steps as necessary

How to use an Evohaler

Using an Evohaler is practically the same as using a pMDI inhaler.

  1. Start off by standing or sitting upright.
  2. Squeeze the sides of the mouthpiece cover and pull to remove it, and ensure the mouthpiece is free of loose particles.
  3. Give the puffer a good shake four or five times to get rid of any loose objects and mix up the medication.
  4. While holding your inhaler upright with your thumb on the base and your index finger on top of the canister, breathe out as far as you can.
  5. Before breathing back in, place the mouthpiece into your mouth and between your teeth, but make sure not to bite down. Close your mouth to make a seal around the mouthpiece.
  6. Slowly begin to take a deep breath in through the puffer. Just after you start to breathe in, firmly push down on top of the canister to release a dose of medicine. Continue your deep breath throughout this.
  7. While holding your breath, take the inhaler from your mouth and remove your fingers from the canister. Keep your breath held for as long as is comfortable, then breathe out.
  8. If you need to take another puff, wait around 30 seconds before repeating steps three to seven.
  9. When you’re done, put the mouthpiece cover back on right away to make sure no dust or other particles get into your puffer. It should click into place.

How to know if you’re using the correct inhaler technique

While all inhalers work on the same basic premise (getting medicine to the place where it’s needed), it’s important to know if the technique that you are using is correct. Your regular asthma review is an ideal time for your doctor or asthma nurse to review your technique and ensure that your asthma medications are reaching your lungs as effectively as possible. There are several tips for getting the best results from your puffer including:

  • Make sure you sit up straight or stand up
  • Form a good, airtight seal around the mouthpiece with your lips
  • Ensure your tongue and teeth don’t get in the way when you inhale
  • Take one breath per dose from your inhaler
  • Use a spacer when needed

Using the correct technique with your puffer is just as important for your preventative medications as it is for treatment in the event of an asthma attack. This is because even well-managed asthma symptoms can escalate quickly unless you consistently use your preventative inhaler.

How to use an inhaler with a spacer

A spacer is an empty plastic tube that has a space for you to slot the mouthpiece of your inhaler into one end, and an integrated mouthpiece at the other. You may also hear of it referred to as an aerochamber, although this is actually one of the different brands of spacer available.

They are recommended for use with metered dose inhalers such as the common pMDI puffer. This is because the medication collects in the chamber of the spacer, letting you breathe it in naturally, rather than trying to get the timing and speed of inhalation exactly right.

Using a spacer with a puffer is simple.

  1. Prepare the dose of medication and your puffer, and then place your inhaler’s mouthpiece into the slot at one end of the spacer
  2. Remove the cap from your spacer’s integrated mouthpiece and place your lips around it, creating a secure seal
  3. Administer a dose of your asthma medication into the chamber
  4. Inhale slowly and steadily, breathing as deeply as you can
  5. Remove the spacer from your mouth and hold your breath for up to 10 seconds
  6. Slowly exhale away from the spacer
  7. If you require a second dose, you can administer this immediately, unless you are using beta-agonists

Spacer and inhaler combinations can be different, so we strongly recommend that you check with your doctor and/or asthma nurse to ensure that you experience minimal side effects.

How to clean a puffer spacer

Keeping your spacer clean and free from harmful microorganisms, it’s important to understand the best techniques for cleaning it. You should use warm water and detergent to clean your spacer, since not all varieties are dishwasher safe. Take your spacer apart and clean each of the surfaces gently in turn – do not scrub. Be careful not to use boiling water as this could damage the spacer. Leave your spacer to air dry before putting it back together.

How frequently should spacer devices be cleaned?

We recommend that you clean your spacer around once every month, or sooner if it looks visibly dirty or the mouthpiece becomes contaminated. If you have had a cough or cold, you may want to clean your spacer to minimise the risk of reinfecting yourself with illness too.

How long do inhalers last?

The medication in most inhaler canisters will expire around one to two years after the device has been issued, although you should check the expiry date stamped directly onto the canister. For an inhaler canister to have the maximum life, it should always be stored correctly.

Ideally, you should replace your spacer at least once every 12 months, or sooner if you spot any signs of visible damage such as cracks or chips in the plastic. If you aren’t sure if yours needs to be updated, speak to your doctor or asthma nurse for advice.

How to store your inhaler

Puffers should be stored at room temperature, out of direct sunlight. The medication within your inhaler canister is pressurised, so it’s crucial not to pierce it or to let it get too hot or cold.

Storing your spacer properly is important to keep it in good condition and working effectively. Spacers should be stored away from dust and liquids which could contaminate them. If you want to store your spacer in a bag, choose a variety that is plastic-free to prevent static from building up in the spacer and affecting the way that it works. A stationary or cosmetics case made from fabric is ideal.

Learn more about different asthma puffers

If you use inhalers for your asthma and you would like to learn more about the different types available, including the techniques for using them, head to our comprehensive comparison page.

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This page was medically reviewed by Dr Daniel Atkinson, GP Clinical Lead on August 02, 2022. Next review due on August 01, 2024.

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