Understanding
Your Inhaler
Contents
You and your inhaler.............................................................................................................................1
Asthma Medicines..................................................................................................................................2
Preventers ........................................................................................................................................ 2
Relievers............................................................................................................................................ 2
Symptom controllers .................................................................................................................. 2
Combinations ............................................................................................................................... 2
Different kinds of asthma inhalers................................................................................................3
Metered dose inhalers (MDI)............................................................................................................4
Spacers ...................................................................................................................................... 8
Smartinhaler.........................................................................................................................10
Dry powder inhalers...........................................................................................................................12
Turbuhaler..............................................................................................................................12
Accuhaler ...............................................................................................................................14
HandiHaler.............................................................................................................................16
Nebulisers..................................................................................................................................................19
Which inhaler is right for me?.......................................................................................................20
Your local affiliated Asthma Societies......................................................................................21
You and your inhaler
This booklet can help you learn how to use your inhaler
correctly. You can reduce the risk of side effects and get
the most from your medicine.
You will also find information on how to clean your inhaler,
store your inhaler and know when your inhaler is empty.
The more you learn about your asthma and how to control
it, the better you will manage your condition.
Why are inhalers useful?
Your inhaler helps you breathe asthma medicine straight
into your lungs.
Asthma medicine taken as pills and syrups takes a long time to get to
your lungs and some gets lost on the journey.
Checking your technique
Get your doctor, nurse or asthma educator to check your inhaler
technique regularly, even if you have been using your inhaler
for some time.
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Asthma Medicines
There are four main groups of asthma medicines:
1 Preventers
(brown/red/orange/yellow inhalers) reduce the swelling and
narrowing inside the airways. They are used every day in asthma.
Preventers are either inhaled corticosteroids (ICS) or non-steroidal
2 Relievers
(usually blue inhalers) relax the muscle in the airway when it is tight
3 Symptom controllers
(pale blue/green inhalers) keep the muscle relaxed and work
for 12 hours. They are used twice daily
4 Combinations
(red/purple inhalers) contain both preventer and symptom
controller medicines
There are different strengths of medicine for each group.
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Different kinds of
asthma inhalers
You can choose between a metered dose inhaler (MDI),
a breath activated aerosol inhaler and a dry powder inhaler.
Talk to your doctor, nurse or asthma educator about the
device that is best for you.
Metered
dose inhalers
Dry powder
inhalers
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Metered dose inhalers (MDI)
MDI inhalers are sometimes called
aerosol inhalers. When the inhaler
is pressed, a measured dose of
medicine is released through the
mouthpiece.
Medicines available in New Zealand
Preventers Relievers Symptom Combination
Beclazone Atrovent Controllers Seretide
Flixotide Respigen Serevent Vannair
Tilade Salamol
Vicrom Ventolin
• Preventer, reliever, symptom • Some people find it difficult
controller and combination to press the inhaler and
D i s a d va n ta g e s
Ad v a n t a g e s
medications are all available breathe in at exactly the
in MDIs right time
• A spacer can improve • It may be hard to tell when
performance the inhaler is empty
• A haleraid device is available • Needs weekly cleaning
for people who have difficulty to prevent blocking
pressing the inhaler
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Recommended age
Children over ten years may be able to use an MDI. However, babies
and young children can use MDIs with a spacer or a spacer and a mask.
Everybody that uses an MDI preventer medication should use a spacer to
receive maximum benefit from their medicine.
Using your inhaler
Metered dose inhalers
• Take off the cap and hold the
inhaler upright
• Shake the inhaler to mix the medication with the propellant
• Sit upright, tilt head back slightly (as if you are sniffing
– ‘sniff position’) and breathe out gently
• Hold the device upright, insert the mouthpiece into
the mouth ensuring that the lips firmly seal the mouthpiece
• At the beginning of a slow, deep breath, breathe in
through the inhaler, activate the aerosol once
• Breathe in fully, remove the MDI from the mouth and
hold breath for ten seconds or as long as is comfortable
• Breathe out gently through the nose
Rinse mouth and spit out or clean teeth after
using a corticosteroid preventer
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Cleaning your inhaler
Clean your inhaler weekly to ensure it doesn’t block (twice weekly if you
use Tilade or Vicrom.)
To clean your inhaler
• REMOVE the plastic mouthpiece cap
• REMOVE the metal canister (don’t put it in water)
• RINSE the mouthpiece and cap under warm water for at least 30
seconds
• SHAKE off any excess water and leave the mouthpiece and cap to
dry overnight.
• Put the metal canister back in, and replace the cap
If you need to use your inhaler before it is dry
• Shake off any excess water from the plastic casing and put the metal
canister back in
• Test spray the inhaler by firing two puffs
into the air
• Take your usual dose
• Wash and dry the inhaler
as described above
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If your inhaler is blocked and you need it immediately
• Rinse the plastic casing as described above
• Shake off any excess water from the plastic casing and put the metal
canister back in
• Test spray the inhaler by firing two puffs into the air
• Take your usual dose
• Wash and dry the inhaler as described above
Metered dose inhalers
Storing your inhaler
• 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 casing in case the one you are using
becomes blocked
Time for a new inhaler
• Shake the device and listen. The contents can be felt and heard
moving around inside the canister
Common mistakes
• Breathing in too fast
• Breathing out so hard 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
• Activating inhaler twice 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
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2 Spacers
A spacer makes your MDI inhaler easy to use and more
effective for people of all ages. Use your spacer with preventer,
reliever, symptom controller and combination medications.
Spacers are clear plastic tubes with a mouthpiece or mask on one end
and a hole for your inhaler at the other. A valve in the spacer mouthpiece
opens as you breathe in and closes as you breathe out.
Spacers can be obtained for free from your doctor for people of all ages
who use an MDI for their medication.
• Many adults and children are unable to use their MDI inhaler
effectively. The spacer reduces the need for perfect technique.
Ad v a n t a g e s
Spacers can be obtained for free from your doctor
• 50% more medicine enters the lungs when a spacer is used
• Less medicine gets left in the mouth and throat. This reduces the side
effects of hoarseness or thrush in your mouth from preventer medicine
• A spacer can help when you are short of breath and an inhaler
by itself is difficult to use
• A spacer is smaller, more convenient and cheaper than a nebuliser.
Studies on adults and children show spacers work just as well as
nebulisers in acute asthma
• Spacers with masks can help very youngchildren inhale their medicine
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Using your spacer
• Shake the inhaler well (holding it upright)
• Fit the inhaler into the opening at the end of the spacer
• Seal lips firmly round the mouthpiece, (or place the mask so it seals
around the nose and mouth.)
• Press the inhaler once only
• Take 1–6 slow breaths in and out through your mouth. Do not
Metered dose inhalers
remove the spacer from your mouth between breaths.
• Remove spacer from your mouth
• Repeat these steps for further doses
Rinse mouth and spit out or clean teeth after using a corticosteroid preventer
Cleaning your spacer
• Wash the spacer with warm water
and dishwashing liquid
• Do not rinse
• Drip dry
Priming
Wash your spacer before you use it for the first time. This is called
“priming.” It reduces static electricity inside your spacer so that the
medicine does not stick to the sides.
Regular washing
After priming, wash your spacer once per week (or more often if using
Vicrom or Tilade.)
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2 Smartinhaler
Smartinhalers contain a
micro-computer to help you
to use your inhaler effectively.
Smartinhalers can be used with a
‘Personal Asthma Manager’ software
programme. Together the software and
smartinhaler allow you to track and control your asthma.
Available types
Smartinhalers are continually being developed for all major medications.
Check [Link] for the latest models.
• Smartinhalers used for preventer
• Smartinhalers
medications contain a reminder
are not
D i s a d va n ta g e s
Ad v a n t a g e s
alarm. This helps you to remember to
subsidised.
take your preventer should you forget.
You will need
• Smartinhalers also contain a ‘fuel to purchase a
gauge’. The fuel gauge shows you Smartinhaler
how much medication is left in your and computer
inhaler so that you can replace your programme
medication before you run out.
• You need
• ‘Personal Asthma Manager’ software to have a
includes an action plan and computer and
educational material, and creates a computer
report of your medication usage and knowledge
peak flow.
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Using your inhaler
Select a smartinhaler that is labeled for use with your medication. The
medication from your standard inhaler is placed inside the smartinhaler.
You can print your report to show your doctor, nurse or asthma educator.
The report displays your progress and enables you and your health care
professional to optimise your asthma management. The educational material
helps you to learn more about your asthma and how to control it, and
includes the latest asthma news from around the world.
Information from the Smartinhaler is uploaded to the ‘Personal Asthma
Manager’ by connecting the Smartinhaler to the PC using a cable (just
like connecting an iPod to a computer).
Cleaning your inhaler
Always keep your cap on your smartinhaler when not in use.
Smartinhaler
Storing your inhaler
Store your smartinhaler in a cool dry place.
Time for a new inhaler
Smartinhalers contain a fuel gauge to indicate when your medication
is getting low.
Common mistakes
Remember to place the medication canister firmly in the smartinhaler
when replacing canisters.
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Dry powder inhalers
Dry powder inhalers are breath activated inhalers. The most common
dry powder inhaler used in New Zealand is the Turbuhaler.
A Turbuhaler
The turbuhaler is breath activated
and has no propellant or carrier
added to the medicine. This means you
will hardly notice any powder in your mouth.
Medicines available in New Zealand
Preventer Reliever Symptom Combination
Pulmicort Bricanyl Controller Symbicort
Oxis
• Preventers, relievers, symptom • The powder cannot be felt or
controllers and combinations tasted when inhaled
are all available in the
Ad v a n t a g e s
D i s a d va n ta g e s
• May clog if exhaled or
Turbuhaler dribbled into routinely or if
• Breath activated stored in an environment
• No propellant or carrier added of high humidity with the
to the medicine cap unsealed. Do not allow
device to get wet
• No powder taste in your mouth
• People with acute asthma
• Special grip for bottom of device
or COPD may have trouble
available for people who find
breathing in deeply. They
device difficult to twist
may prefer to use an MDI
and spacer
Pa g e 1 2
Recommended age of use
• 5–7 years to adult
Using your inhaler
• Unscrew and remove the cap
• Hold the Turbuhaler upright. Turn the grip as far as it will go and then
back to the original position – listen for the click. (Repeating will not
double the dose)
• Sit upright, and breathe out gently
• Insert the mouthpiece into the mouth holding the inhaler
horizontally ensuring that the lips are firmly sealed
• Breathe in steadily and deeply
• Remove the Turbuhaler from the mouth, then breathe out gently
through the nose
• Replace the cap securely
Rinse mouth and spit out or clean teeth after using a corticosteroid preventer
Cleaning your inhaler
Do not allow device to get wet when cleaning.
Wipe the mouthpiece with a dry cloth. Do not wash the mouthpiece.
Keep the cap on when not in use.
Time for a new inhaler Dry powder
There is a window under the mouthpiece
inhalers
on the outside of the Turbuhaler called
the ‘Empty Soon Indicator.’ When a red
mark or a number appears at the top of
the window, there are approximately
20 doses left.
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Common Mistakes
• Not holding the inhaler upright when priming
• Covering the air inlets with lips
• Breathing in through the nose instead of the mouth
• Shaking the inhaler to see how much is left
• Storing inhaler in a damp environment with the cap off
B Accuhaler
Accuhaler is a breath activated
device. Doses of the medicine
are set into a foil strip inside the
Accuhaler.
Medicines available in New Zealand
Preventer Symptom Controller Combination
Flixotide Serevent Seretide
• No propellant • Taste of lactose carrier
Disadvantages
Ad v a n t a g e s
• Attached cover protects • Unable to retrieve
the mouthpiece missed doses
• Individually foiled doses • Bulky size for carrying
protect medication from
moisture
• Dose counter
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Recommended age
• 5–7 years to adult
Using your inhaler
• Open the device by holding the outer case. Using the thumb grip,
slide the cover open as far as it will go
• Face the mouthpiece towards the person using the device
• Push the lever away from the mouthpiece until you hear the ‘click’
• Sit upright, tilting the head back (as if you are sniffing – ‘sniff’
position) and breathe out gently
• Insert the mouthpiece into the mouth ensuring that your lips firmly
seal the mouthpiece
• Breathe in fully, remove Accuhaler from the mouth and hold breath
for 10 seconds or as long as is comfortable
• Breathe out gently through the nose
• Slide the thumb grip back over the mouthpiece
• Repeat if second dose required
Rinse mouth and spit out or clean teeth after using a corticosteroid preventer
Cleaning your inhaler
• Wipe the mouthpiece with a dry cloth, or clean with a tissue after use
Time for a new inhaler
Dry powder
inhalers
• The number of doses remaining is displayed, with the last five
numbers in red
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Common mistakes
• Exhaling into device
• Not ‘clicking’ lever after opening cover
• Breathing in through the nose instead
of the mouth
C HandiHaler
The HandiHaler delivers the
medication Spiriva which is used
by people with Chronic Obstructive
Pulmonary Disease (COPD).
Medicines available in New Zealand
Spiriva
• Able to taste, feel, hear and • People with poor eyesight
see that the dose has and/or hand coordination
Disadvantages
Ad v a n t a g e s
been delivered may find it difficult to use
• Can check if complete dose • Taste of lactose carrier
has been delivered. • Inconvenience of having to
carry separate capsules of
medication
Pa g e 1 6
Recommended age
Not usually used for children as HandiHaler contains medication
prescribed for COPD.
Technique
• Spiriva capsules come in a blister strip. Separate blister strips to
create two strips of five capsules
• Peel back the foil from one blister strip to expose one capsule
• Open the HandiHaler protective cover and mouthpiece
• Place the capsule in the centre chamber
• Close the mouthpiece firmly until a click is heard, leaving the
protective cover open
• Holding the HandiHaler upright, pierce the capsule by pressing the
green button in completely once
• Sit upright, tilt head back (into ‘sniff’ position) and breathe out
gently. Do not breathe into the device. Insert the mouthpiece into
the mouth ensuring that the lips are firmly sealed
• Breathe in slowly and deeply. The sound of the capsule vibrating in
the chamber will be heard. Remove the HandiHaler from the mouth
and hold the breath for 10 seconds or as long as possible. Breathe
out gently through the nose.
• Check to see if any powder remains in the capsule. If so repeat the
process from ‘sit upright’
Dry powder
• Open the mouthpiece. Tip out and dispose of the used capsule.
inhalers
Close the mouthpiece and protective cover to prevent dust/dirt
settling on the mouthpiece and being inhaled
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Time to get some more Spiriva
• Count the capsules left in the box
• Handihaler device may need to be replaced after one year.
Replacement Handihalers incur a small charge
Cleaning your inhaler
Clean once a month
• Open the protective cap, mouthpiece and base
• Rinse whole device with warm water and air-dry thoroughly
for 24 hours
• Clean outside of mouthpiece with a damp tissue when needed
Common Mistakes
• Piercing capsule more than once could
lead to inhaling capsule particles
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Nebulisers
Nebulisers are an alternative way to take medicine. They produce
a fine mist of the medicine, which is breathed in through a mask or
mouth piece. They are either powered by an electrical air pump or
oxygen. It should take ten to fifteen minutes to breathe in the dose
of medication.
A nebuliser is mainly used for reliever medicine.
With so many improved inhaler devices and spacers there is now
less need for nebulisers. Research proves that spacers are just as
effective in acute asthma for adults and more effective for children
than nebulisers.
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Which inhaler is right for me?
When asthma medicines are used correctly, they are very safe – even for
small children and pregnant women. Inhaled asthma medicines are best
as they work quickly and require only small amounts of drug.
Inhalers make it easy to get your medication in the right place at the right
time. They are an important part of asthma care.
And because inhalers come in many different shapes and sizes, it’s easy to
find the one that suits you best.
For up-to-date respiratory information check out our website
[Link] or contact your local Asthma Society.
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Your local affiliated Asthma Societies
Asthma Society Northland (Inc.) Asthma & Respiratory Management BOP Inc.
WHANGAREI TAURANGA
Ph: 09-438-5205 Ph: 07-577-6738
Kaikohe (branch of Northland) Asthma & Respiratory Management BOP Inc.
KAIKOHE WHAKATANE
Ph: 09-405-2227 Ph: 07-307-8082
07-577-6738
Asthma and Respiratory Services Eastern Bay of Plenty Asthma
(Waikato) Inc and COPD Support Group
HAMILTON WHAKATANE
Ph: 07-838-0851 Ph: 07-307-1447
0800-227-363
Taranaki Asthma Society Asthma Rotorua
NEW PLYMOUTH ROTORUA
Ph: 06-751-2501 Ph: 07-347-1012
Taupo Asthma Society
Asthma Hawke’s Bay (branch of Rotorua)
NAPIER TAUPO
Ph: 06-835-0018 Ph: 021-190-2363
Tu Kotahi Maori Asthma Trust Gisborne & East Coast
LOWER HUTT Asthma Society (Inc.)
Ph: 04-939-4629 GISBORNE
0800-939-462 Ph: 06-868-9970
Wairarapa Asthma Society
Nelson Asthma Society
MASTERTON
NELSON
Asthma Marlborough Ph: 06-377-1175
Ph: 03-546-7675
BLENHEIM
Ph: 03-579-1609
Southland Asthma Society Inc
INVERCARGILL
Canbreathe
Ph: 03-214-2356
CHRISTCHURCH
0800-800-240
Ph: 03-366-5235
North Otago Asthma Society
OAMARU
Ph: 03-434-3202
Otago Asthma Society
DUNEDIN
Ph: 03-471-6167
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Produced by the Asthma Foundation - updated February 2013.
© Asthma and Respiratory Foundation of New Zealand (Inc.) Photocopy permission granted
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UPDATED SEPTEMBER 2013 - ASTH06