Children at Risk for Using the Wrong Asthma Inhaler Technique

With falling leaves, windy conditions, and cold weather; seasonal changes can trigger symptoms in those who have asthma. It can also be a year-round struggle for some. The chronic inflammation of airways can be well-controlled by using an inhaler correctly, but recent studies indicate children don’t understand the proper technique, putting themselves at risk for complications and even death.

In a recent University of Chicago study, scientists analyzed the asthma medication inhalation technique in a group of children ages 8-14. Of the 65 kids monitored, 97% misused their inhaler. Another study published in the Journal of Hospital Medicine describes scientists who observed 113 children ages 2-16 hospitalized for asthma-related complications. 55% had uncontrolled asthma, and 42% missed critical steps when using their inhalers.

“When I ask patients in the hospital to show me how they take their inhalers, I discover that many of them are not taking them correctly,” said California respiratory care specialist Ricardo Guzman, MA, RRT, RCP. “This leads to patients not receiving the intended dose and even a lack of compliance as patients incorrectly assume their medication does not work for them,” said Guzman.

Some techniques children are skipping include removing the cap off the inhaler, attaching it to a spacer, completely exhaling before inhaling the medication, and keeping the medication inside the breath for at least five seconds. A spacer is a tube attached to an inhaler that holds the medication inside a chamber until the user can inhale all the medication. Misusing a spacer or not using one at all can cause the medication to land on the tongue or throat instead of the lungs. Most health insurance companies do not cover the cost of spacers, so many children go without one.

Results from the University of Chicago study also indicate misplaced confidence in parents and children who both overestimated the kids’ ability to use asthma devices properly.

“It is important to recognize that the pharmaceutical industry has not made it easy for patients,” Guzman said. “Currently there are at least six different types of inhalers on the market, all with their own set of instructions,” said Guzman. Many healthcare providers and parents are also failing to instruct children on the proper use of inhaler devices, according to Guzman.

Guzman recommends following these twelve steps for anyone, adult or child, who is using a traditional inhaler, also known as a metered dose inhaler (MDI), with a spacer.

  1. Remove the cap
  2. Shake the inhaler if required by medication instructions
  3. Attach the inhaler to a spacer
  4. Sit up or stand up straight and hold the inhaler upright
  5. Exhale completely away from inhaler before inhalation
  6. Place inhaler mouthpiece between teeth, sealing the lips
  7. Release the medicine with one spray during inhalation
  8. Inhale slowly and deeply (If the spacer whistles, that means the inhale is happening too quickly)
  9. Hold the breath for five to ten seconds
  10. Remove the inhaler or spacer from the mouth
  11. Exhale and breath normally
  12. Wait one minute and repeat the process

Storing, charging, and cleaning devices can also help ensure inhalers will work correctly.

You can find a video demonstrating the proper asthma inhaler technique by the American Lung Association at

If you wish to seek professional help from a respiratory therapist on an asthma inhaler technique, you can check their license to make sure it is valid and in good standing by visiting the Respiratory Care Board at

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