Inhaler Update

After the first few puffs, most people with asthma become comfortable with their inhalers. As long as the device works for them, they see no need for change. But for millions of people with asthma, the last decade brought some big changes.

About 85 percent to 90 percent of today’s inhalers are metered-dose inhalers. Just like aerosol cans, these devices contain pressurized gases that propel the medicine. Until fairly recently, most of the inhalers contained chlorofluorocarbons (CFCs), gases that harm the ozone layer. As part of a worldwide effort to reduce the release of these gases, CFC inhalers became unavailable in the United States after December 31, 2008.

Fortunately, asthma patients don’t need CFC inhalers to keep their condition under control. Patients have a wide variety of effective, easy-to-use options that are environment-friendly, and more new inhalers are on the way.

Proventil HFA, for one example, is a metered-dose device that uses gases other than CFCs. This inhaler delivers albuterol, a common medication that helps open up airways. QVAR, a similar inhaler, delivers the corticosteroid drug beclomethasone. Both of these inhalers work much the way other metered-dose inhalers do, but patients may notice small differences in the taste of the medicine and the force of the spray.

Some patients may feel that they aren’t getting as much medicine with the HFA inhaler, but studies reported in the New England Journal of Medicine say that’s not the case. Studies found no difference in the amount of medicine in patients’ bloodstream after two puffs from HFA and CFC inhalers. And in fact, after 12 puffs, the level of medicine in the blood stream was higher with an HFA inhaler.

Some doctors think that problems users are having with HFA inhalers are due to inhalation technique rather than how well the inhaler operates. Because the spray from an HFA inhaler is narrower and less forceful, patients may need to inhale more slowly to take in the medicine. Talk to your doctor if you don’t feel your HFA inhaler is working as well for you as your old CFC inhaler. Your doctor may suggest that you practice a different way of inhaling.

Dry-powder inhalers are an excellent alternative for many patients. These inhalers don’t have any gases at all; as with metered dose inhalers, the patient uses his or her own lung power to suck in the medicine. The devices are already widely available and easy to use, but they aren’t a good choice for very young children, people with emphysema, or anyone else who can’t inhale strongly enough to get the medicine.

Other devices include mini-nebulizers, handheld inhalers that deliver a fine spray without the help of pressurized gases. These allow some patients with severe respiratory problems much more mobility than they may have had before.

Whatever type of inhaler you have, follow the instructions exactly and talk with your doctor to make sure you are using it correctly. If you have any doubts, bring it along to your next appointment and demonstrate your technique.

How to use an inhaler

Metered-dose inhalers:

To prepare a metered-dose inhaler, place the canister, nozzle down, in the plastic holder, then remove the cap from the inhaler. It’s important to shake the canister before each dose. You may want to use a spacer, a tube that carries medicine from the inhaler directly to the mouth. A spacer lets patients breathe at their own pace and helps deliver the medicine deep into the airways. Spacers are especially helpful for young children and people taking corticosteroids.

Tilt your head back slightly and slowly breathe out.

If using a spacer, attach the spacer to the inhaler, put one hand around the spacer and one hand on the inhaler, and place your mouth firmly around the end of the spacer. If you’re not using a spacer, place the mouthpiece into your mouth and close your lips around it tightly.

While breathing in slowly, press down on the inhaler to release the medicine.

Keep breathing in deeply and evenly for three to five seconds, then hold your breath for 10 seconds.

If you need another dose, wait for 30 to 60 seconds before repeating the steps.

If you’re using a corticosteroid, rinse your mouth out after each use; this will help lessen your risk of developing yeast infections in your mouth or your throat.

Dry-powder inhaler:

Put your mouth around the mouthpiece and inhale quickly and deeply. Remove the inhaler from your mouth and hold your breath for 10 seconds.

Further Resources

American Academy of Allergy, Asthma, and Immunology, 800-822-ASMA,

American College of Allergy, Asthma, and Immunology, 800-842-7777,

American Lung Association, 800-LUNG USA,

Asthma and Allergy Foundation of America, 800-7-ASTHMA,


Mayo Clinic. Asthma inhalers: Which one’s right for you? 2009.…

National Jewish Health. Using a metered-dose inhaler. 2009.…

Hendeles L, et al. Withdrawal of Albuterol Inhalers Containing Chlorofluorocarbon Propellants. N Engl J Med 2007;356:1344-51.

Doctors Hear Gripes About HFA Inhalers. MedPage Today. March 11, 2009.…

Drug Shortages, Center for Drug Evaluation and Research, Food and Drug Administration, Last updated July 30,2007

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