This is a highly informative summary about different inhaler devices regarding their use, storage, looking after them, common mistakes during use and when to start a new inhaler. Have a nice look. Taking into your consideration that all images are hyperlinked with videos demonstrating the use of inhalers and cleaning which greatly helps you to master the techniques.

1. Inhaler Devices

3. ILOS
 Different types of inhaler
devices
 How to use the inhaler
 How to asses proper use of the
inhaler
 Common mistakes when using
the inhaler
 How to look after the inhaler
 Storing the inhaler
 When to start a new inhaler
In-Check DIAL G16 Inspiratory
Flow Measurement
(inspiratory flow
<30 l/min)
slow and steady
inhalation (gentle)
through the mouth
Aerosol MDI and
Respimat devices
DPI ( multiple
dose or capsule)
(inspiratory flow
30-60L/min)
Inhales forcibly
and deep through
the mouth

4. Metered Dose Inhalers (aerosol) Dry Powder Inhalers Soft Mist Inhalers
Pressurized
MDI
Breath-actuated MDI Multiple Dose
Inhalers
Single Dose Inhalers
(Capsule)
Respimat
• Easybreathe
• Autohaler
• Accuhaler
• Ellipta
• NEXThaler
• Turbohaler
• flexhaler
• Twisthaler
• Clickhaler
• Novolizer
• Pressair
• Respiclick
• Forspiro
• Easyhaler
• Aerolizer
• Breezhaler
• Handihaler
• zonda
• Rotahaler
Inhaler Devices

5. Aerosol Inhalers General Roles
 Straighten and slightly extend backward the neck
 Aerosol: Shake for 5 seconds
 Open and prepare
 Exhale away from device through the mouth
 Good lip seal
 Aerosol: slow and steady inhalation (gentle) through the
mouth(inspiratory flow <30 l/min) and at the same time press down
firmly on the canister
 Take the inhaler out while holding breath
 Hold the breath for 10 seconds
 Close the inhaler
 Rinse the mouth and do not swallow (if it contains steroids)
10
9
8
7
6
5
4
3
2
1

6. Aerosol (p MDI)

Propellant

Priming
4
puffs
in
the
air
away
from
your
face
•
New
one
•
Not
used
for
2
weeks
Vental
Ventolin
Asmol
Atimos
Metrovent
Atrovent
Atrovent Comp
Ipravent s
Beclo
Beclosone
Beclosone forte
Clenil forte
Budecort
Flixotide
Alvesco
Vental Comp
Flutiform
Seretide
Trimbow

7. Remove the cap
Hold the inhaler upright and shake well
Breathe out gently away from the inhaler
Put mouth piece between teeth without biting
and close lips to form good seal
Breathe in slowly through mouth and at the same
time press down firmly on the canister
Keep breathing in slowly and deeply
Hold breath for about 10 seconds
While holding breath remove inhaler from mouth
Breathe out gently away from the inhaler
If an extra dose is needed repeat steps 2-10
Replace the cap
Checklist p MDI use

8. How to look after your MDI
 our inhaler can get blocked, especially
where the medicine sprays out.
 Clean your inhaler weekly.
 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.

9. Storing your inhaler
 Keep the cap on your inhaler.
 Keep your inhaler at the correct temperature.
 Keep your inhaler somewhere dry.
 Carry a spare clean plastic case so you can
change it if the one you are using becomes
blocked.

10. By shaking the inhaler
Always have a spare inhaler ready
It may help to write the start date on
the inhaler
When to start a new inhaler

11. Common problems when using 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).
 Stop breathing in when feeling the aerosol.
 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.

12. P MDI
spacer

13. Valved
holding
chambers
Antistatic
Aero
chamber
Spacer
Non
anti
static
(traditional)

14. Single breath method ( adult)
Multiple breath method ( children)
Multiple breath method < 4 years

15. Assemble spacer (If necessary)
Remove inhaler cap
Hold inhaler upright and shake well
Insert inhaler upright into spacer
 Put mouthpiece between teeth without biting and
close lips to form good seal
Breathe out gently, into the spacer
Hold spacer level and press down firmly on inhaler
canister once
Breathe in slowly and deeply .
Hold breath for about 10 seconds
While holding breath, remove spacer from mouth
 Breathe out gently
 Remove inhaler from spacer
 If an extra dose is needed, repeat steps 2 to 14
 Replace cap and disassemble spacer
Checklist p MDI &
spacer (Single Breath)

16. Assemble spacer" (If necessary)
Remove inhaler cap
Hold inhaler upright and shake well
Insert inhaler upright into spacer
Put mouthpiece between teeth without biting and
close lips to form good seal
Breathe out gently, into the spacer
Hold spacer level and press down firmly on inhaler
canister once
Breathe in and out normally for 3 or 4 breaths
Remove spacer from mouth
Breathe out gently
Remove Inhaler from spacer
If an extra dose is needed, repeat steps 2 to 14
Replace cap and disassemble spacer
Checklist p MDI & spacer
(Tidal Breathing )

17. When and how to prime the spacer
 New spacer
 After cleaning
 long time without use
 6 Puffs

18. How to look after your spacer
 Wash your spacer once a week
 with warm water and dishwashing liquid. Don’t rinse. Drip dry.
This reduces the electrostatic charge so that the medicine does
not stick to the spacer sides


19. When to replace the spacer
 Check for cracks if present .
 If used regularly your spacer
may need to be replaced every
12-24 months.

20. Aerosol (breath actuated MDI )
Easi- Breathe
• Shake
• Slow steady inhalation
• Breath activated for release
of medication
• Priming (2 puffs)
• Do not block vents above
• 2 in 1
Easi-Breathe
Qvar

21. Aerosol ( breath actuated )
Autohaler
• Shake
• Slow steady breath in
• Breath activated for
release of medication
• Push lever up
Airomir
qvar

22. Dry Powder Inhalers General Roles
 Click (hear and do not repeat)(not for release of medication)
 Straighten and slightly extend backward the neck
 Open and prepare
 Breath activated ( breathing in release the medication)
 Do not shake (except easyhaler)
 Exhale away from device through the mouth
 Good lip seal
 Inhales forcibly and deep through the mouth(inspiratory flow 30-60L/min)
 Take the inhaler out while holding breath
 Hold the breath for 10 seconds
 Close the inhaler
 Rinse the mouth and do not swallow (if it contains steroids)
10
9
8
7
6
5
4
3
2
1

23. Dry Powder (Multiple Dose Inhalers)
Accuhaler (Diskus)
Horizontal
Seretide
Flixotide
Serevent

24. Check dose counter
Open cover using thumb grip Hold horizontally
load dose by sliding lever until it clicks
Breathe out gently, away from the inhaler
Place mouthpiece in mouth and close lips to form
a good seal, keep inhaler horizontal Breathe in
steadily and deeply
Hold breath for about 10 seconds
While holding breath, remove inhaler from mouth
Breathe out gently, away from the inhaler
If an extra dose is prescribed repeat steps 3 to 9
Close cover to click shut
Checklist for diskus use

25. Dry Powder (Multiple Dose Inhalers)
Ellipta

Do
not
block
vent

2-in-1
Trelegy
incruse

26. Check dose counter
Slide the cover down until you hear a click
(do not shake)
Breathe out gently, away from the inhaler
Place mouthpiece in mouth and close lips to
form a good seal
Do not cover air vent
Breathe in steadily and deeply
Hold breath for 10 seconds
While holding breath, remove inhaler from
mouth
Breathe out gently, away from the inhaler
Sade the cover upwards as far as it will go, to
cover the mouthpiece
Checklist for Ellipta use

27. Dry Powder (Multiple Dose Inhalers)
NEXThaler

Do
not
block
vent

2-in-1
Fostair

28. Dry Powder (Multiple Dose Inhalers)
Turbohaler
Twist
Symbicort
Oxis
Bricanyl

29. Unscrew and remove cover
Check dose counter
Keep inhaler upright while twisting grip
Twist around and then back until click is heard
Breathe out gently, away from the inhaler
Place mouthpiece between teeth without
biting and close lips to form a good seal.
Do not cover air vents
Breathe in strongly and deeply
Hold breath for about 10 seconds
Remove inhaler from mouth
Breathe out gently away from the inhaler
If an extra dose is needed, repeat steps 2 to 10
Replace cover
Checklist Turbohaler
for use

30. Dry Powder (Multiple Dose Inhalers)
Pulmicort

31. Dry Powder (Multiple Dose Inhalers)
Twisthaler
Arrow
should
line
up
with
the
dose
counter
Asmanex

32. Dry Powder (Multiple Dose Inhalers)
Clickhaler
Click
Asmasal
Asmabec

33. Dry Powder (Multiple Dose Inhalers)
Novolizer
Cartilage
Salbulin
Budelin

34. Dry Powder (Multiple Dose Inhalers)
Pressair(Genuair)
Green
-Red
Eklira
Duaklir

35. Dry Powder (Multiple Dose Inhalers)
Respiclick( spiromax)
2
in
1
Spiromax
Duoresp

36. Dry Powder (Multiple Dose Inhalers)
each single dose contained in a separate blister
in a foil strip
Forspiro
airflusal

37. Dry Powder (Multiple Dose Inhalers)
Easyhaler
Shake
Ventolin
Formoterol

39. Remove cap
Hold base and twist mouthpiece to open (follow
arrows)
Remove capsule from blister and place in chamber
Close mouthpiece
Press side buttons in together once and release
Breathe out gently, away from the inhaler
Place mouthpiece in mouth and close lips to form a
good seal, keep inhaler horizontal Breathe in
quickly and deeply
Hold breath for about 10 seconds .
While holding breath, remove inhaler from mouth
Breathe out gently
Open mouthpiece to check if capsule is empty If
powder remains repeat steps 6 to 11
 Open mouthpiece and remove capsule
If more than one dose is needed repeat steps 3-12
Close mouthpiece and cap
Checklist for
Breezhaler use

41. Remove cap
Flip mouthpiece to open
Remove capsule from blister and place in chamber
Close mouthpiece until It clicks
Press side buttons in once and release (do not
shake)
Breathe out gently, away from inhaler
Put mouthpiece between teeth without biting and
close lips to form good seal Breathe in quickly and
steadily, so capsule vibrates
Hold breath for about 10 seconds
 While holding breath, remove inhaler from mouth
Breathe out gently, away from Inhaler
Open mouthpiece to check if capsule is empty If
powder remains repeat steps 6 to 11
Open mouthpiece and remove capsule
 If more than one dose is needed repeat steps 3-12
Close mouthpiece and cap
Checklist for
Breezhaler use

42. Dry Powder (Single Dose Inhalers)
Handihaler
Spiriva

43. Open cap
Flip open mouthpiece
 Remove capsule from blister and place in chamber
 Close mouthpiece until It clicks
Press green piercing button in once and release (do
not shake)
Breathe out gentry, away from inhaler
Place mouthpiece between teeth without biting
and close lips to form a good seal
Breathe in slowly and deeply , so capsule vibrates
Keep breathing in for 10 seconds
 While holding breath, remove inhaler from mouth
Breathe out gently, away from inhaler
Open mouthpiece to check if capsule is empty If
powder remains repeat steps 6 to 11
 Open mouthpiece and remove capsule.
If more than one dose is needed repeat steps 3-12.
Close mouthpiece and cap
Checklist for
Handihaler use

46. Cleaning the inhaler device

wipe the mouthpiece with a
clean dry tissue.
Do not wash the mouthpiece
or allow it to get wet when
cleaning.

47. Storing your inhaler
Keep the cap on your inhaler.
Keep your inhaler at the correct
temperature.
Keep your inhaler somewhere dry.
Store all medicines safely

48. When to start a new inhaler
Dose Counter
(Turns red or 00)

49. Common problems when using DPI
 Not loading a dose before using the inhaler.
 Tilting your head down – it should be tilting back slightly.
 Not breathing in strongly enough to draw the medication
out of the inhaler and in to your lungs.
 Stop breathing in when feeling the powder.
 Breathing in through the nose instead of the mouth.
 Breathing out when taking the inhaler out of the mouth .
 Not holding your breath long enough after using the
inhaler.
 Getting moisture inside the inhaler.
 Not closing the inhaler cover after use.
 Swallowing the capsule.
 Not piercing the capsule or multiple piercing.

51. Hold inhaler upright with the cap closed
Turn base in direction of arrows until it clicks
Open the cap until it snaps fully open
Breathe out gently, away from inhaler
Place mouthpiece in mouth and close lips to form
a good seal.
 Do not cover air vents
Breathe in slowly and deeply through mouth and,
at the same time, press down on the dose button
Keep breathing in slowly and deeply
Hold breath for 10 seconds
While holding breath, remove inhaler from mouth
Breathe out gently, away from inhaler
Click cap shut
Two inhalations is the usual dose for medicines
used with Respimat, Repeat from step 1 to get the
full dose
Checklist for Respimat
use

52. Metered Dose Inhalers
(aerosol)
Multiple Dose DPI Single Dose DPI (Capsule) Respimat

53. Choose check Correct Confirm
Strategies to ensure effective use of inhaler devices