Display Patient Information Leaflets

Date issued: December 2024 

For review: December 2026  

Ref: C-605/JWC/Chest Clinic/Steps to success and going green          

PDF: Inhalers Steps to success and going green.pdf[pdf] 453KB

 

Which inhaler is right for you?

The most important factors your healthcare provider will consider when prescribing you an inhaler are your diagnosis, clinical need, and your ability to use a device. 

When looking to prescribe an inhaler your clinician should: 

• Assess your inspiratory flow.
• Assess your manual dexterity. 
• Consider your preference of device and inhaler regimen. 
• Provide teaching and then assess your ability to use a device. 

The best inhaler device for you is always going to be the one you can and will want to use.

 

Why we want to get it right

Poor inhaler technique and poor inhaler use can be associated with poor symptom control and worsening outcomes including: 

• ED Attendances
• Hospital Admissions
• Increased oral steroid use.
• Increased antibiotic use.

Other factors which need to be taken into consideration by your prescriber are:

Formulary availability: the formulary is a selective list of available medications. This can differ slightly from region to region. Not all inhalers will be available on your local formulary. 

Cost:  your prescriber will consider cost effectiveness in terms of measured outcomes such as improved symptom control and reduced exacerbations as well as resource use. Sometimes inhalers have the same licensed indications, the same active ingredients, and similar device characteristics. In such cases it makes sense to choose the cheaper option. 

Environmental factors:  Achieving the best outcomes for the patient and the planet.

• According to NHS England, the health and care system in England is responsible for an estimated 4-5% of the country’s carbon footprint. 
• Inhalers account for 3% of the total NHS carbon emissions. Propellant gases within metered dose (aerosol) inhalers are the main culprit. 
• Environmental impacts also arise during the manufacturing process and end-of-life waste disposal​.

Find out more about greener NHS

Read NICE guidelines for Asthma

 

Going Green: How can you help?

Consider a change to a dry powder inhaler

Dry powder inhalers have a lower carbon footprint compared with multi-dose inhalers. If you are able to take a strong, deep breath in, you may be able to switch to this type of device. Speak to your healthcare provider if you are interested in changing to lower carbon footprint inhaler. A change may not be suitable if your symptoms are unstable.

Make sure you know how to use your inhaler correctly

Read the below guides on how to effectively use your inhaler device. This will ensure your inhaler is optimised to improve your lung condition, which can reduce acute illness and may reduce overall use of your inhalers.

Do not over order inhalers

Whilst it is important to never run out of your inhalers, it is also helpful to manage your stock at home and not order unnecessarily. For example, order a salbutamol (blue) inhaler only when you need to, rather than with every repeat prescription.

Dispose of your inhalers appropriately

Do not dispose of your inhalers in your normal household waste. Instead, please return them to your pharmacy for safe disposal. Inhalers returned to pharmacies will be incinerated at a high temperature which destroys the propellant gases so they can’t escape into the atmosphere. Some pharmacies will also have inhaler recycling schemes. 

 

Using Your Inhaler

Pressurised Metered Dose Inhaler (pMDI)

1. Some pMDIs have a dose counter. If yours has one check it is not empty

2. Hold your inhaler upright. Remove Cap

3. Shake inhaler well

4. Breathe out fully, away from inhaler

5. Slightly tilt your chin up. Close lips around mouthpiece to create a good seal. Do not bite

6. Start to breath in slowly and press down on the canister at the same time

7. Continue to breathe in slowly and deeply until your lungs feel full

8. Remove inhaler from mouth and hold breath for 5–10 seconds (as able)

9. Breathe out gently away from the inhaler 

10. If an extra dose is needed, wait approximately 30 seconds, and repeat steps 2-8

11. Replace cap.

12. If you have had an inhaler that contains steroids rinse your mouth with water. 

Wash spacer as per manufacturer’s instructions

 

Pressurised Metered Dose Inhaler (pMDI) and spacer  (Multiple breath technique)  

1. Hold your inhaler upright. Remove cap

2. Shake inhaler well

3. Insert inhaler into the spacer

4. Remove cap from mouthpiece of the spacer

5. Breathe out fully

6. Tilt your chin up slightly. Close lips around spacer mouthpiece to create a good seal. Do not bite.

7. Press the canister once to release the dose

8. Take 5 slow controlled breaths in and out (if you hear a whistling sound you’re breathing too quickly)

9. Remove spacer from your mouth and breathe out

10. For a second dose, wait 30 seconds and repeat steps 2-9.

11. Remove the inhaler from the spacer and replace caps on inhaler and spacer.

Wash spacer as per manufacturer’s instructions

 

Easi-Breathe Breath Actuated (aerosol) Inhaler

1. Hold inhaler upright and shake well

2. Open the cap which covers the mouthpiece

3. Hold the inhaler upright – don’t cover the vents

4. Breathe out fully then place inhaler in your mouth

5. Breathe in slowly and deeply

6. Remove inhaler from mouth and hold breath for 5–10 seconds (as able)

7. Breathe out gently away from the inhaler

8. Hold the inhaler upright and close the cap

9. For a second dose, repeat steps 1-8

10. If you have had an inhaler that contains steroids rinse your mouth with water.

 

Respimat Device (soft mist inhaler)  

1. Before first use, make sure you have loaded and primed the device as per manufacturer’s instructions

2. Hold inhaler upright. Turn the base in the direction of the arrows on the label until it clicks (half a turn).

3. Open the cap

4. Breathe out fully, away from inhaler

5. Close lips around spacer mouthpiece to create a good seal. Do not bite.

6. While taking a slow and deep breath in through your mouth press the dose release button and then continue to breathe in slowly for as long as you can

7. Remove inhaler from mouth and hold breath for 5–10 seconds (as able)

8. Breathe out gently away from the inhaler

9. Close the cap

10. Repeat steps 2-9 for a second dose