Inhaler Technique

The National Asthma Education Program recommends the following inhaler instruction protocol.

  • Clinician demonstration of proper technique from an approved checklist.
  • The patient rehearses technique with a provider to allow for correction.
  • Periodic evaluation of technique with corrections as necessary.
  • Positive reinforcement for proper technique.

Table 4 – Inhaler Technique

Inhaler Type


MDI Technique

  • Remove or open the cover to the mouthpiece
  • For first use, prime the MDI by shaking it for five seconds and activating four puffs into the air away from the face.  Subsequent use requires shaking for 5 seconds to suspend medication in the canister
  • Hold the inhaler upright with fingers on top of the canister and thumb on the bottom
  • Breath out a normal breath
  • Close lips around mouthpiece or place mouthpiece 1-2 inches in front of the mouth
  • Press down on the canister to activate the device as the initiation of the next breath begins
  • Continue inhaling slowly through the mouth
  • Once the lungs are full, hold breath for 10 seconds to allow medication to traverse the lungs
  • Breath out normally
  • Wait 10-15 seconds in between puffs.  Shake inhaler before use again
  • If using a steroid inhaler, gargle with warm water and spit.  Do not swallow
  • Replace or place the cover back on the mouthpiece

SMI technique

The cartridge will need to be inserted the first time the device is used.  Below are the cartridge insertion instructions:

  • Press safety catch and pull off the plastic base
  • Push the cartridge into the inhaler until it catches
  • Push the cartridge against a firm surface to make sure it is firmly locked
  • Do not remove the cartridge again
  • Place base on, it should click in place
  • Do not remove the base again
  • The inhaler needs to be primed prior to the first dose
  • Hold the inhaler upright and turn the base clockwise until it clicks
  • Open the cap and point inhaler to the floor
  • Activate the inhaler until you see a mist and repeat x 3
  • If the inhaler has been used in the last 3 weeks, then repeat x1.  If it has been longer than 3, weeks repeat x4
  • Instructions to take a dose
  • Turn the base of the inhaler clockwise until it clicks
  • Open the cap
  • Completely exhale air from the lungs
  • Insert mouthpiece in mouth and place the inhaler horizontally, aiming towards the back of the throat
  • Seal lips around inhaler, taking care not to cover side vents
  • As you initiate a deep, slow breath inwards, activate the inhaler
  • Breath in deeply and hold your breath for 10 seconds
  • Remove the inhaler from the mouth and breathe out slowly

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