Getting Medicine to Your Lungs

For people with asthma or chronic obstructive pulmonary disease (COPD), using an inhaler is the fastest method of delivering medication to the lungs.

It is also the safest; the risk of side effects is lower than with tablets or capsules. That's because after being absorbed in the gastrointestinal tract, medication taken orally must travel through the bloodstream to get to your lungs, and on the way to the lungs, it affects other organs as well. With inhaled medications, most of the medicine stays in the airways, with much less reaching the bloodstream.

Inhaled medications can be delivered three ways. The most common way is to use a metered dose inhaler (MDI), a pressurized canister that releases an aerosol spray. The U.S. government now requires that all inhalers use a type of propellant known as hydrofluoroalkane (HFA). This propellant is more friendly to the environment than the ozone-damaging chlorofluorocarbons (CFCs), which were previously used in MDIs.

Proper technique

An inhaler can be difficult to use because it requires coordination between the release of the medication and your inhalation. Even when an inhaler is used correctly, most of the medication sticks to the back of the throat, and no more than 10 to 20 percent of it actually reaches the lungs.

The key to getting the most from your inhaler is to use the proper technique. If you follow these steps, more of the medicine will reach your lungs. If you're still not sure you're using the inhaler correctly, ask your doctor to watch you as you use it to make sure that you are employing the proper technique.

  1. Read the directions on the package insert about shaking and priming the inhaler (releasing a certain number of sprays in the air before you use the inhaler).
  2. Place the metal canister into the plastic mouthpiece.
  3. Remove the cap from the mouthpiece and shake the inhaler for five to 10 seconds.
  4. Breathe out to the end of a normal breath (don't force air out).
  5. If your doctor recommends the open-mouth technique, hold the mouthpiece of the inhaler one to two inches (about the width of two fingers) from your mouth, tilt your head back slightly and open your mouth wide. If your doctor recommends the closed-mouth technique, place the mouthpiece in your mouth with your lips sealed tightly around it. For both techniques, breathe in slowly as you press down once on the metal canister to release a puff of medication. (You must breathe in more slowly with HFA inhalers than with CFC inhalers.)
  6. Continue to inhale until your lungs are full (about five seconds). Inhaling too quickly will increase the amount of the medicine that sticks to the back of the throat.
  7. Hold your breath for 10 seconds or as long as you can do so comfortably.
  8. Before you exhale, be sure to remove the inhaler from your mouth and release your fingers from the canister.
  9. Replace the cap on the mouthpiece to avoid contamination by dust and other particles.
  10. For an additional dose, wait one minute and then repeat steps 3 through 9.
  11. Clean the plastic mouthpiece once a week by removing the metal canister and rinsing the plastic portion in warm water; allow it to air dry. Replace the metal canister and the cap on the mouthpiece. Because the new inhalers tend to clog more easily, it's especially important to clean them regularly. Check your inhaler's package insert for specific cleaning instructions.

Publication Review By: Peter B. Terry, M.D., M.A.

Published: 06 Aug 2013

Last Modified: 15 Sep 2015