Inhaler devices

An inhaler is a device used to deliver medicine to the lungs and airways. It is mainly used to treat or prevent diseases of the airways such as asthma, chronic obstructive pulmonary disease (COPD) or cystic fibrosis. By getting medicine directly to the lungs, smaller doses of medicine are needed and it can start working more quickly.

The main types of inhaler devices are metered dose inhalers and dry powder inhalers.

Metered dose inhalers  

• Metered dose inhalers are also called MDIs or aerosol inhalers.
• The medicine is in a small canister, inside a plastic case. When the inhaler is pressed, a measured dose of medicine comes through the mouthpiece.
• MDIs require good technique and coordination by pressing down on the inhaler and breathing in at the same time.
• Because using the inhaler correctly can be difficult, spacer devices are recommended for use with MDIs. The spacer is attached to the MDI to make it easier to use the inhaler and get more medicine into the lungs.

Read more about metered dose inhalers below.

Dry powder inhalers

• Dry powder inhalers are handheld devices that deliver medication to the lungs and airways as you inhale through it.  
• Examples of dry powder inhalers include: 
  • Turbuhaler
  • Accuhaler
  • Handihaler
  • Ellipta inhaler
  • Breezhaler

Respimat device (soft mist inhaler)

• The Respimat device is a soft mist inhaler. It is a hand-held device in which medication in a liquid form is converted to a fine mist which is then inhaled. 
• Using the soft mist inhaler needs some co-ordination, to press down slowly and breath in at the same time.
• The soft mist inhaler has been shown to leave less medication in the throat with more reaching the lungs, as compared with the metered dose inhaler.

Read more about the Respimat device below.

• Inhaled medicines are an important part of asthma and COPD care.
• Because inhalers come in many different shapes and sizes, you can find the one that suits you best, by talking with your doctor or asthma educator. Not all medicines are available in all inhalation devices. You may want to try some devices before choosing the one which you are most comfortable with.

If the inhaler devices are unsuitable, your doctor may recommend the use of a nebuliser. Read more about nebulisers.

• To get the most benefit from the medication, it is important to use the correct technique when using your inhaler. This is so you get the right amount of medication and that it reaches deep inside your lungs.
• Ask your doctor, pharmacist, or nurse to show you how to use your inhaler device.
• Even if you've had asthma or COPD for a long time and have used the same inhaler for years, it's still worth reminding yourself regularly how they work.

The metered dose inhaler or MDI is an aerosol inhaler used to deliver a short burst, or puff, of medication.

• The medicine is in a small canister, inside a plastic case.
• When the inhaler is pressed, a measured dose of medicine comes through the mouthpiece.
• Exactly the same dose is released each time.
• MDIs contain different medicines including preventers, relievers, symptom controllers and combinations of medications. Read more about asthma medicines in adults, asthma medicines in children and medications for COPD. 

Using your metered-dose inhaler (puffer)

(National Asthma Council, Australia, 2011)

How to use your MDI (puffer)
	Take off the cap and hold the inhaler upright.
	Shake the inhaler to mix the medication.
	Sit upright, tilt your head back slightly (as if you are sniffing) and breathe out gently.
	Hold the device upright, insert the inhaler into your mouth, ensuring that your lips firmly seal the mouthpiece. At the beginning of a slow, deep breath, breathe in through the mouthpiece as you press the inhaler to release one dose or 'puff'.
	Breathe in fully, remove the inhaler from your mouth and hold your breath for 10 seconds or as long as is comfortable. Breathe out gently through your nose.

Using a spacer

A spacer is an attachment to use with your MDI. Using a spacer with your MDI makes it easier to use the inhaler and helps to get the medicine into your lungs, where it’s needed (with less medicine ending up in your mouth and throat). Spacers improve how well your medicine works. Children over 10 years may be able to use an MDI without a spacer; however, babies and young children must use MDIs with a spacer or a spacer and a mask. Read more about spacers.

Common mistakes when using the MDI

• Breathing in too fast.
• Breathing out so hard that you cough.
• Pressing the puffer too early before you have started to breathe in (if you see a mist of medication from your mouth, then you are making this mistake).
• Tilting your head down – it should be tilting back slightly.
• Pressing the inhaler two times during a single inhalation.
• Giving the inhaler a 'test puff' into the air and wasting the medication.
• Breathing in through the nose instead of the mouth.

How to look after your MDI

• Your inhaler can get blocked, especially where the medicine sprays out.
• Clean your inhaler weekly to ensure it doesn't get blocked.
• To clean the inhaler, remove the plastic cap, remove the metal canister (don't put it in water), rinse the plastic case under warm water for at least 30 seconds.
• Shake off any excess water, and leave the plastic case and cap to dry overnight.
• Put the metal canister back in, and replace the cap.

Storing your MDI

• Always keep the cap on your inhaler when it is not in use.
• Store spare inhalers in cool places (not in car glove boxes).
• Carry a spare clean plastic case so you can change it if the one you are using becomes blocked.

When to start a new inhaler

• By shaking the inhaler it is possible to hear if there is any medicine left in the canister.
• Always have a spare inhaler ready, start this before the old one is completely empty.
• It may help to write the start date on the inhaler, so you can work out how long it will last with daily use. There are usually 200 puffs per canister. 

The turbuhaler is a breath-activated device – this means that it will release a dose of medication when you inhale on the mouthpiece.  

• The turbuhaler delivers the medication in a dry-powder form. There is no propellant added to the medicine.
• When you breathe in a dose of the medication, you will hardly notice any powder in your mouth.
• Preventers, relievers, symptom controllers and combination medicines are available as turbuhalers.

Examples of medicines available as a turbuhaler
terbutaline (Bricanyl) formoterol (Oxis) budesonide plus formoterol (Symbicort) budesonide (Pulmicort)

When is a turbuhaler suitable? 

Since the turbuhaler is a breath-activated device, to use the turbuhaler properly, you must be able to breathe in deeply. 

• Adults and children 7 years of age and older should be able to use the turbuhaler.
• Some people, such as those with severe COPD may not able to breathe in well enough to activate the turbuhaler.

If you are unsure if the turbuhaler is the correct device for you, talk to your doctor, nurse or pharmacist. 

How to use your turbuhaler

To get the most benefit, it is important to use the correct technique. Ask your doctor, pharmacist, or nurse to explain how to use your turbuhaler. Here is some guidance:

(Healthify NZ & Auckland District Health Board, 2018)

Using your turbuhaler

• Open: unscrew and remove the cap. Hold the turbuhaler upright.
• Load the dose: twist the base anticlockwise and then back in the other direction until you hear a click. Your turbuhaler is now loaded with one dose of medicine
• Breathe out: breathe out, away from the turbuhaler. Do not blow directly into the turbuhaler.
• Inhale your dose: place the mouth piece in your mouth and form a seal with your lips. Breathe in deeply. Remove the turbuhaler and hold your breath for up to 10 seconds.
• Close: replace the cap and twist until it is on properly.

Cleaning and storing your turbuhaler: wipe the mouthpiece with a clean dry tissue. Do not wash the mouthpiece or allow it to get wet when cleaning. Keep the cap on when not in use. The device may clog if exhaled or dribbled into or if stored in an area of high humidity with the cap off or unsealed.

When to start a new turbuhaler: there is a window under the mouthpiece on the outside of the turbuhaler called a dose indicator window. When it turns red it is time to get a new turbuhaler. 

Common problems when using a turbuhaler

To get the most benefit, it is important to use the correct technique. Here are a few common problems: 

• Not holding  your turbuhaler upright (vertical) while loading the dose.
• Covering the air inlets with your lips.
• Breathing in through your nose instead of your mouth.
• Shaking the inhaler to see how much is left.
• Storing your turbuhaler in a damp place with the cap off.

An accuhaler is a breath-activated device – this means that it will release a dose of medication when you inhale on the mouthpiece. 

• Doses of the medicine are preloaded in foil-covered blister packets inside the device. 
• There are 60 doses in each accuhaler; these can be counted with the dose counter on the device.

Examples of medicines available as an accuhaler
salmeterol (Serevent) fluticasone (Flixotide) fluticasone and salmeterol (Seretide)

When is an accuhaler suitable?

Since the accuhaler is a breath-activated device, you must be able to breathe in deeply, to use it properly. 

• Adults and children 4 years and older should be able to use an accuhaler.
• Some people, such as those with severe COPD may not able to breathe in deeply enough to activate the accuhaler.

If you are unsure if the accuhaler is the correct device for you, talk to your doctor, nurse or pharmacist.

How to use your accuhaler

To get the most benefit, it is important to use the correct technique. Ask your doctor, pharmacist, or nurse to explain how to use your accuhaler. Here is some guidance:

(NHS UK, 2016)

Using your accuhaler

• Open: hold the accuhaler in one hand, and with the thumb of the other hand push the thumb grip away from you until you hear a click. This reveals the mouth piece.
• Load the dose: hold the inhaler in a horizontal position. Slide the lever away from you until you hear a click.
• Breath out: breathe out, away from the accuhaler. Do not blow directly into your device.
• Inhale your dose: place the mouth piece in your mouth and form a seal with your lips. Breathe in deeply and forcefully through your mouth. Remove the accuhaler and hold your breath for up to 10 seconds. If you need another dose, wait for 30 seconds and then repeat the process
• Close: the inhaler by sliding the thumb grip towards you.

Cleaning and storing your accuhaler: wipe the mouthpiece with a clean dry tissue. Do not wash the mouthpiece or allow it to get wet when cleaning. Close the device when not in use. 

When to start a new accuhaler: there is a window on the side of the accuhaler called a dose counter. When it turns red it is time to get a new accuhaler.

Common problems when using an accuhaler

To get the most benefit, it is important to use the correct technique. Here are a few common problems:

• Not loading a dose before using the accuhaler.
• Not holding the accuhaler horizontally while loading and inhaling the dose. Never hold the inhaler with the mouthpiece pointing down during or after loading a dose; this can cause the medication to fall out. Keep it horizontal.
• Not breathing in strongly enough to draw the medication out of the accuhaler and in to your lungs.
• Not holding your breath long enough after using the accuhaler.
• Getting moisture inside the accuhaler.
• Not closing the accuhaler cover after use.

The handihaler is used for the medication tiotropium (also called Spiriva capsules). Do not swallow the capsules - they must be used by inhaling the contents of the capsule with the handihaler device provided.

• The handihaler is a breath-activated device – this means that it will release a dose of medication when you inhale on the mouth piece.
• Tiotropium (Spiriva capsules) is used for people with COPD. Read more about tiotropium.

How to use your HandiHaler

To get the most benefit, it is important to use the correct technique when using your Handihaler. Ask your doctor, pharmacist, or nurse to show you how to use your Handihaler. Here is some guidance:

(Healthify NZ & Auckland District Health Board, 2018)

Using your HandiHaler

• Open: press the green button on the side of the handihaler to open the lid. Lift the lid to see the mouthpiece. Pull on the mouthpiece to reveal the capsule chamber.
• Load the capsule: Spiriva capsules come packaged in blister strips. Peel back the foil from one blister strip to release one capsule. Place the capsule into the capsule chamber. Close the mouthpiece firmly until you hear a click.
• Pierce the capsule: press the green button on the side to pierce the capsule.
• Breathe out: sit upright, tilt head back (into 'sniff' position) and breathe out gently. Do not breathe into the device.
• Inhale your dose: put the mouthpiece into your mouth and seal lips firmly around it. Breathe in rapidly and deeply through your mouth. You will hear the sound of the capsule vibrating in the chamber. Remove the Handihaler from your mouth and hold your breath for  up to 10 seconds.
• Take two breaths from one capsule: to get your full daily dose, you must use your inhaler two times from the same Spiriva capsule. You will not need to pierce the capsule again.
• Discard the used capsule: after inhaling your dose, open the mouthpiece and discard the used capsule. Close the mouthpiece and the lid of the inhaler.  

Common problems when using the Handihaler

To get the most benefit, it is important to use the correct technique. Here are a few common problems:

• Piercing the capsule several times or not piercing the capsule at all.
• Not breathing in strongly enough to draw the medication out of the inhaler.
• Not taking a second breath to get the full dose from the capsule.
• Swallowing the capsule instead of inhaling it through the HandiHaler.
• Not using a new capsule for each dose.

The Respimat device is a soft mist inhaler. It is a hand-held device in which medication in a liquid form is converted to a fine mist which is then inhaled.  

• There is no propellant added to the medicine. It is converted into a fine mist by a compressed spring inside the inhaler.
• Using the soft mist inhaler needs some co-ordination, to press down slowly and breath in at the same time.
• The soft mist inhaler has been shown to leave less medication in the throat with more reaching the lungs, as compared with the metered dose inhaler.

Examples of medicines available as a fine mist

• tiotropium (Spiriva Respimat)
• tiotropium + olodaterol (Spiolto Respimat)

How to use your Respimat device 

To get the most benefit, it is important to use the correct technique. Ask your doctor, pharmacist, or nurse to show you how to use your Respimat device. Here is some guidance:

(Healthify NZ & Auckland District Health Board, 2018)

If using your Respimat device for the first time

• Insert the cartridge: keep the cap closed. Remove clear base - press the safety catch while firmly pulling the base with other hand. Insert the narrow end of the cartridge into the inhaler. Press down on a hard surface (such as a table) to secure the cartridge into the device and close the base.
• Prime the inhaler: to ensure the device releases the medicine properly, you will need to prime it. Do this by turning the clear base in the direction of the arrows on the label until it clicks (half a turn). Open the cap, push the release button on the front, until you see the mist come out of the mouth piece. You may need to do this a few times.

Inserting the cartridge and priming the Respimat device can be tricky. Ask you pharmacist to load the cartridge for you.

To use your Respimat device 

• Load the dose: hold the inhaler upright with the cap closed. Turn the base in the direction of arrows until until you hear a click.
• Breath out: breathe out, away from the device. Do not blow directly into your device.
• Inhale your dose: open the cap and press your lips around the mouthpiece without covering the air vents on either side. Breathe in slowly and deeply through your mouth. Press the dose release button and continue to breathe in. Hold your breath for up to 10 seconds. Breathe out slowly.

When to start a new device: there is a counting device on the side of your inhaler, to tell you how many doses are left. When it gets into the red section, it is time to get a new inhaler.

The Ellipta inhaler is a preloaded, breath-activated device – this means that the inhaler has the medication inside and will release a dose of medication when you inhale on the mouthpiece.  

• The Ellipta inhaler delivers the medication in a dry-powder form.
• There is no propellant added to the medicine.
• When you breathe in a dose of the medication, you will hardly notice any powder in your mouth.

Examples of medicines available as a Ellipta inhaler
umeclidinium + vilanterol (Anoro Ellipta) fluticasone furoate + vilanterol (Breo Ellipta) umeclidinium (Incruse Ellipta)

How to use your Ellipta inhaler

To get the most benefit, it is important to use the correct technique. Ask your doctor, pharmacist, or nurse to explain how to use your Ellipta inhaler. The following is a guide:

(Healthify NZ & Auckland District Health Board, 2018)

Using your Ellipta inhaler

• Remove the device from the foil packing.
• Open: pull back the mouth piece cover until you hear a click. Hold the device upright at all times. Breath out away from the device.
• Inhale your dose: press your lips around the mouthpiece without covering the air vents on either side. Begin to breathe in rapidly and deeply through your mouth. Hold your breath for up to 10 seconds. Breathe out slowly. Close the mouth piece cover.

Cleaning and storing your Ellipta inhaler: clean your device once a week by wiping the mouthpiece with a clean dry tissue. Do not wash the mouthpiece or allow it to get wet when cleaning. Close the device when not in use. Store it in a cool dry place, away from heat and moisture.

When to start a new inhaler: there is a window on the front of your Ellipta inhaler called a dose counter. When it turns red it is time to get a new inhaler.

The Breezhaler is a breath-activated device – this means that it will release a dose of medication when you inhale on the mouthpiece.

• The Breezhaler delivers the medication as a dry-powder. There is no propellant added to the medicine. 
• When you breathe in a dose of the medication, you will hardly notice any powder in your mouth.

Examples of medicines available as a Breezhaler
glycopyrronium (Seebri) indacaterol (Onbrez)  glycopyrronium + indacaterol (Ultibro Breezhaler)

How to use your Breezhaler device

To get the most benefit, it is important to use the correct technique. Ask your doctor, pharmacist, or nurse to show you how to use your Breezhaler device. Here is some guidance:

(Healthify NZ & Auckland District Health Board, 2018)

Using your Breezhaler device

• Open: remove the cover to expose the mouth piece. Pull back the mouthpiece to reveal the capsule chamber.
• Insert the capsule: the capsules come packaged in a foil wrapping. Pull back the foil edges to release one capsule. Do not remove the capsule by pushing it through the foil – this will damage the capsule. Place the capsule into the capsule chamber. Close the mouth piece until you hear a click.
• Pierce the capsule: hold the inhaler upright and press both side buttons at the same time. You should hear a click as the capsule is pierced. Then release the side buttons.
• Inhale your dose: put the mouthpiece into your mouth and seal lips firmly around it. Breathe in rapidly and deeply until your lungs are full and hold your breathe for 10 seconds. You will hear the sound of the capsule vibrating in the chamber.
• Take two breaths from one capsule: to get your full daily dose, you must use your inhaler two times from the same capsule.
• Discard the used capsule: after inhaling your dose, open the mouthpiece and throw away the used capsule. Close the mouthpiece and the lid of the inhaler.

Cleaning and storing your Breezhaler: you can clean your device by wiping the mouthpiece with a clean dry tissue. Do not wash the mouthpiece or allow it to get wet when cleaning. You will get a new Breezhaler with your repeat prescription every month. Close the device when not in use. Store it in a cool dry place, away from heat and moisture.

Common problems when using a Breezhaler

• Shaking the inhaler.
• Not piercing the capsule.
• Not using a new capsule for each dose.
• Not breathing in hard enough.

Understanding your inhaler(external link) The Asthma Foundation, NZ
Inhaler chart(external link) Counties Manukau Health, NZ, 2021
Understanding your inhaler(external link) The Asthma Foundation, NZ, 2013
Using your inhaler [PDF, 577 KB] Airways Education Group, 2010

Asthma in adults
Asthma in children | Mate huango tamariki
COPD | Mate ia tuku
Nebulisers

1. Inhaler technique in adults with asthma or COPD(external link). National Asthma Council Australia.
2. How to teach inhaler technique(external link) Nursing Times, 2011