COPD and inhalers: which mistakes are common and how to avoid them?
A guide for people with COPD and their families on using inhalers properly and why technique matters as much as the medicine itself.
In short
- With an inhaler, technique is part of the treatment: if it goes wrong, less medicine reaches the lungs.
- The most common mistakes are not breathing out first, not coordinating the puff with breathing in, and not holding your breath afterwards.
- After using a steroid inhaler it is advisable to rinse your mouth with water and spit it out.
- Ask your doctor, nurse or pharmacist to check your technique regularly, not just on the first day.
In chronic obstructive pulmonary disease (COPD), an inhaler only works if it is used properly. The most common mistakes are simple to correct: empty the lungs first, breathe in slowly and deeply while pressing the canister, hold your breath for a few seconds and, if it contains a steroid, rinse your mouth afterwards.
Each type of inhaler has its own technique, so what we explain here is for guidance only: the reference is always the leaflet and the instructions of your healthcare team.
| What will you find in this article? |
Why does inhaler technique matter so much?
Because the medicine has to reach the airways, and that depends on how you breathe when using it. With poor technique, much of the dose stays in the mouth or throat and the treatment seems not to work even when taken every day.
Mistakes are common. In a Spanish study published in Archivos de Bronconeumología, only 31.6% of 554 people with long term respiratory conditions used their inhaler correctly, and technique was better among those who had received instructions. That is why guidelines insist that a professional should check technique regularly.
What are the most common mistakes?
Most mistakes relate to breathing: before, during and after the inhalation. It is also common not to shake the canister or to run out of doses without noticing.
| Mistake | How to avoid it |
|---|---|
| Not emptying the lungs first | Breathe out slowly, without blowing into the inhaler |
| Pressing without breathing in at the same time (pressurised inhaler) | Start breathing in slowly and press once while still breathing in, or use a spacer |
| Not holding your breath | Hold your breath for about 10 seconds, if you can |
| Taking two puffs in a row | Wait the time stated in the leaflet between puffs |
| Not rinsing after a steroid inhaler | Rinse your mouth with water, gargle and spit |
| Not checking the dose counter | Check it and order the next inhaler before it runs out |
How do you use a pressurised inhaler properly?
The basic steps are to shake, breathe out, seal your lips, breathe in slowly while pressing once, and hold your breath. MedlinePlus and Spanish public health service prescribing bulletins describe a very similar sequence:
- Sit or stand with your back straight.
- Remove the cap and shake the inhaler well.
- Breathe out slowly and deeply.
- Place the mouthpiece between your teeth and seal your lips around it.
- Start breathing in slowly, press once and keep breathing in slowly and deeply.
- Remove the inhaler and hold your breath for about 10 seconds.
- If another dose is needed, wait as long as the leaflet says.
Dry powder inhalers are different: they are not shaken, they need a strong breath in and you must not blow into them. That is why it is important to learn the technique for your specific device.
When does a spacer help?
A spacer makes a pressurised inhaler easier to use when it is hard to coordinate pressing with breathing in, which is common in older people. The medicine stays in the spacer and is breathed in from it more calmly.
- Check that your inhaler fits your spacer model.
- Press once and breathe in straight away; if it is hard to do in a single breath, you can take several breaths through the spacer.
- Wash it according to the manufacturer's instructions and let it air dry.
Ask your doctor or pharmacist whether a spacer is suitable for your inhaler.
A practical example: Manuel and the inhaler that did not seem to work
Let us take the case of Manuel, 77, who has COPD and takes five other medicines a day. He uses two inhalers and says they do nothing for him. His daughter watches and sees that he presses the canister before starting to breathe in and lets the air out straight away.
- They go to the pharmacy together and ask the pharmacist to check his technique with the inhaler in hand.
- The pharmacist corrects his coordination and suggests asking his doctor whether a spacer would make it easier.
- His daughter writes the steps on a card next to the inhaler and reminds him to rinse after the steroid.
- At his next check up, Manuel takes both inhalers so the nurse can check his technique.
If your relative refuses treatment, our guide for when an older person refuses medication may help.
How can IMA Health help?
People with COPD often take other oral medicines as well. IMA Health coordinates with a specialised pharmacy that prepares that medication by day and time of each dose, with home delivery and personalised follow-up, so the routine is simpler and nothing is left untaken. To support consistency, see also strategies to improve treatment adherence.
Sources
- MedlinePlus: how to use an inhaler without a spacer (Spanish)
- SESCAM, Castilla-La Mancha prescribing bulletin: inhaler devices for asthma and COPD
- Murcia Salud, Preevid: structured inhaler technique education in COPD (2026)
- Carrión Valero F, et al. Inhalation technique in chronic respiratory diseases. Archivos de Bronconeumología, 2000
- NHS: COPD treatment
This article is for information only and does not replace advice from your doctor or pharmacist.