What an inhaler does and why COPD patients need one
An inhaler is a handheld device that delivers medicine directly into your lungs. For COPD, inhalers are the main way to get the medications that open your airways and reduce inflammation. The medicine reaches your lungs faster and in smaller doses than a pill would, which means it works more quickly and causes fewer side effects in the rest of your body.
There are two main types of inhalers: rescue inhalers (also called reliever or quick-relief inhalers) that work within minutes when you are short of breath, and maintenance inhalers (also called controller or preventer inhalers) that you use every day to keep your airways open and prevent flare-ups. Most people with COPD use both.
Using an inhaler correctly matters more than you might think. If you do not use the right technique, most of the medicine stays in your mouth or throat instead of reaching your lungs, and you do not get the benefit. Your doctor or a respiratory therapist can watch you use your inhaler and correct your technique — this is worth asking for at every visit.
Key Takeaways
- Rescue inhalers work within minutes and are for sudden shortness of breath; maintenance inhalers are used daily to prevent symptoms.
- Proper technique — breathing in slowly, holding the breath, and timing the spray correctly — determines whether the medicine reaches your lungs.
- A spacer (a tube that attaches to your inhaler) makes it easier to get the medicine into your lungs, especially if your hands or timing are not steady.
- Your doctor should watch you use your inhaler and correct your technique at least once a year, because most people develop bad habits over time.
- If you need your rescue inhaler more than twice a week, your COPD is not well controlled and you should contact your doctor.
Rescue inhalers: when to use them and what to expect
A rescue inhaler contains a bronchodilator — usually albuterol (also called salbutamol outside the US) — that relaxes the muscles around your airways within 5 to 15 minutes. You use it when you suddenly feel short of breath, when you are about to do something that makes you short of breath (like climbing stairs), or during a COPD flare-up.
The rescue inhaler is not meant to be used every day. If you find yourself reaching for it more than twice a week, that is a sign your COPD is not well controlled and you need to talk to your doctor about adjusting your maintenance inhaler or your daily routine. Overusing a rescue inhaler can also make your airways more sensitive over time.
Rescue inhalers are usually blue or gray. Carry yours with you at all times — keep one at home, one in your bag or car, and one at work if you spend most of your day there. Check the expiration date every few months and refill it before it runs out.
Maintenance inhalers: daily use to prevent symptoms
Maintenance inhalers contain medications that work over hours or days to keep your airways open and reduce swelling. You use them every day, even when you feel fine. There are several types: some contain a bronchodilator alone, some contain a corticosteroid (which reduces inflammation), and some contain both. Your doctor chooses based on how severe your COPD is and how well your lungs respond.
Common maintenance inhalers include tiotropium (Spiriva), fluticasone and salmeterol (Advair), and budesonide and formoterol (Symbicort). These are usually brown, orange, red, or green. Set a daily time to use your maintenance inhaler — right after brushing your teeth in the morning, for example — so you do not forget. If you use a corticosteroid inhaler, rinse your mouth with water after each use to prevent a fungal infection in your throat.
It can take two to four weeks of daily use before you notice the full benefit of a maintenance inhaler. Do not stop using it because you feel better; it is working because you are using it. If you still have symptoms after four weeks, tell your doctor — you may need a different medication or a higher dose.
How to use a metered-dose inhaler (MDI) correctly
A metered-dose inhaler, or MDI, is the most common type. It is a small pressurized canister in a plastic holder. Here is the step-by-step technique:
- Shake the inhaler firmly for 10 to 15 seconds.
- Remove the cap and hold the inhaler upright.
- Breathe out fully through your mouth.
- Place the mouthpiece between your teeth and close your lips around it, or hold it about one inch in front of your open mouth (ask your doctor which method works best for you).
- Press down on the canister to release the medicine while you breathe in slowly and deeply through your mouth for 3 to 5 seconds.
- Hold your breath for 10 seconds (or as long as you can manage).
- Breathe out slowly through your nose.
- If you need a second puff, wait 30 to 60 seconds, shake the inhaler again, and repeat.
The most common mistake is breathing in too fast or not holding your breath long enough. Breathing in slowly gives the medicine time to reach deep into your lungs instead of staying in your mouth. Holding your breath gives the medicine time to settle in your airways.
Using a spacer to make inhalers easier
A spacer (also called a holding chamber) is a tube that attaches to your inhaler. It holds the medicine in a chamber for a few seconds, giving you time to breathe it in without having to time the spray perfectly. Spacers are especially useful if you have arthritis or tremors that make it hard to press and breathe at the same time, or if you have trouble coordinating the steps.
To use an inhaler with a spacer: shake the inhaler, attach it to the spacer, press the canister once to release the medicine into the chamber, place the mouthpiece in your mouth, and breathe in and out normally five to six times. The medicine will travel into your lungs with each breath. Spacers work for both rescue and maintenance inhalers.
Ask your doctor whether a spacer would help you. Many people benefit from one, and insurance often covers them. Clean your spacer once a week by washing it in warm soapy water and letting it air dry — do not wipe the inside, as this creates static that can trap the medicine particles.
Dry powder inhalers and other types
Some maintenance inhalers are dry powder inhalers (DPIs), which require you to breathe in quickly and forcefully to pull the powder into your lungs. Common examples are Ellipta, Turbuhaler, and Diskus devices. These are not suitable for rescue use because they require strong breathing effort, which is hard to do when you are already short of breath.
DPIs work well for people with strong lungs and good hand coordination, but they are harder to use if you have weak lungs, arthritis in your hands, or trouble with timing. If your doctor prescribes a DPI, ask them to watch you use it and confirm you are doing it correctly. If you struggle with it, tell your doctor — you may do better with an MDI and spacer instead.
Some people use both types: a DPI for daily maintenance and an MDI with a spacer for rescue. There is no single "best" inhaler — the best one is the one you will use correctly and consistently.
Cleaning, storing, and tracking your inhalers
Clean the plastic holder of your MDI once a week by rinsing it in warm water and letting it air dry. Do not submerge the metal canister itself. Wipe the mouthpiece with a dry cloth before you use it.
Store your inhalers at room temperature, away from heat and direct sunlight. Do not leave them in a hot car or a cold garage. Keep them in a dry place — moisture can clog the mouthpiece.
Track how often you use your rescue inhaler by writing down the date and time each time you use it, or by setting a phone reminder to check how many times you used it that week. This information helps your doctor see whether your COPD is getting worse or better, and whether your maintenance inhaler is working. If you use your rescue inhaler more than twice a week, bring this record to your next appointment.
When to contact your doctor about your inhaler
Contact your doctor if you are using your rescue inhaler more than twice a week, if you need it at night more than once a week, or if you wake up short of breath even though you use your maintenance inhaler every day. These are signs that your current treatment is not working well enough.
Also contact your doctor if you have side effects from your inhaler — tremors, a racing heart, or a sore throat — or if you cannot figure out how to use your inhaler correctly even after practicing. Do not just stop using it; tell your doctor so they can switch you to a different medication or device.
Seek emergency care (call 911 or go to the emergency room) if you are short of breath and your rescue inhaler does not help within 15 minutes, if you cannot speak in full sentences, or if your lips or fingernails turn blue. These are signs of a severe flare-up that needs when ready treatment.
Frequently Asked Questions
Can I use someone else's inhaler if I run out?
No. Inhalers are prescribed based on your specific lung function and medical history. Using someone else's inhaler could give you the wrong dose or the wrong type of medicine. If you run out, contact your pharmacy or doctor for a refill, or go to an urgent care clinic if you cannot reach your doctor.
Why do I need to rinse my mouth after using my maintenance inhaler?
Maintenance inhalers often contain a corticosteroid that can cause a fungal infection (thrush) in your mouth and throat if it sits there. Rinsing with water after each use washes away the medicine that did not reach your lungs. You do not need to rinse after a rescue inhaler.
How do I know if my inhaler is empty?
Most MDI canisters have a dose counter on the side that shows how many puffs are left. If yours does not, you can estimate by dividing the total number of doses (usually printed on the label) by how many you use per day. Mark your calendar for when you expect to run out, and refill it a few days early so you never run out.
What should I do if I accidentally use my maintenance inhaler as a rescue inhaler?
One extra dose will not harm you. Just go back to your normal schedule the next day. If you are confused about which inhaler is which, ask your pharmacy to label them clearly or use a pill organizer with compartments labeled by day and time.
Can I use my inhaler while wearing a face mask?
Yes, but you need to remove the mask to use it. Lift the mask just enough to place the mouthpiece in your mouth, use the inhaler, hold your breath, and then replace the mask. If you are in a medical setting, tell staff you need to use your inhaler so they can help you do it safely.