The most commonly prescribed device is the pressurized metered dose inhaler (pMDI), Its major drawback is the requirement that inspiration and actuation of the device be well coordinated. The newer multidose dry powder inhalation devices (DPIs) are breath actuated, thus facilitating coordination with inspiration, and contain fewer ingredients. Asthma education is always needed to instruct patients on the effective use of the numerous inhalation devices available.

With all inhaler types, error rates increase with age and the severity of air?ow obstruction. Even after the training is provided, some patients will continue to have difficulties using inhalers properly.

Correct technique depends on the inhaler type, so patients need to understand the right steps for their own inhaler. Patients using a pMDI are much more likely to have poor technique when using their device without a spacer. The use of spacers helps overcome the problem of coordinating inspiration with actuation

Even when patients are able to demonstrate correct technique during consultation with a health professional, they may not maintain this standard at other times. Those instructed to use a spacer may subsequently revert to using their pMDI alone.

For Metered-dose Inhalers (pMDI)

There are 3 different methods for using metered-dose inhalers (MDIs):

• Closed-mouth method
• Spacer method
• Open-mouth method

The open-mouth technique used to be the preferred method before 2008 when the propellant in the MDIs changed. The spacer method is often preferred for controller medicines. A spacer deposits less medicine in your mouth and the back of your throat. With a spacer, you can inhale more medicine directly into your lungs, where you need it. The next preferred method is the closed-mouth method. It’s important to become very familiar with the method you use. This will ensure that you get the most benefit from your medicine.

Many people use several inhalers at a time. You may wonder which inhaler you should use first. Keep in mind that bronchodilators work faster than inhaled steroids. Use bronchodilators first because these fast-acting inhalers open your airways quickly. Use the inhaled steroids last, so then they can go deeper into your lungs.

The general rules are:

• First, use your fastest-acting bronchodilator, for example, Albuterol.
• Next, use any other bronchodilators prescribed for your regular use, for example, Atrovent or Serevent.
• Last, use your steroid inhaler.