7+ Inhaler Mistakes You Need to Stop Making (Before You End Up on Prednisone)

Studies show that 70% to 80% of people are using their inhalers incorrectly. That means if two of your friends are also using inhalers, at least two of them are using it wrong—maybe all three.

And when your inhaler doesn’t work, your asthma doesn’t stay under control.

When your asthma isn’t under control, that’s when you end up on prednisone pills.

I’ve also done training at the pulmonary medicine clinic at a university hospital. Plus I’ve personally had to use inhalers, and I have family members with asthma.

So this isn’t just textbook for me.

In this guide, I’m walking you through the 11 inhaler mistakes people are making that could be sabotaging your asthma control and putting you one flare away from prednisone pills.

(The title says seven—seven’s a great number, but once I got there, I just couldn’t stop adding more because I’ve seen so many mistakes people make. Plus seven just sounds better, right?)

We’re going to go in the order you should actually be using your inhaler, so by the end you’ll have a complete process. You’ll understand exactly how to avoid those mistakes that 70% to 80% of people make.

And be sure to stick around for the last mistake, because it has nothing to do with technique at all. It actually has to do with which inhaler you’re using and when—and the answer might genuinely surprise you and maybe even your doctor.

Watch now!

Why This Actually Matters

Your inhaled steroid—the controller medication in your inhaler—works by calming down inflammation in your lungs. It’s your first line of defense.

But here’s the thing: If you’re not using it correctly, medication isn’t actually getting into your lungs where it needs to go. It’s landing on the back of your throat, or worse, just floating around in the air around you.

Research tells us that even in the best case with perfect technique, only about 40% of the medication from an inhaler actually reaches your lungs.

And in the worst case, if you make all the mistakes I’m about to tell you about, only about 4% to 5% of the medication deposits in your lungs where it needs to be to actually help you.

That’s a difference of 10 times.

So let’s get you 10 times better at using your inhaler.

What Happens When Your Technique Fails

When your technique is failing, the inflammation builds up unchecked in your lungs. Your airways get irritated and start to spasm. You cough. You can’t sleep at night. You end up in a flare.

And then your doctor prescribes prednisone pills, which works but comes with a whole list of at least 150 side effects of its own.

The good news? Many of these mistakes are completely fixable. If you fix them, your inhaler may work dramatically better—which means your asthma stays under control, which means you may never need that prednisone prescription in the first place.

Let’s go through these in order, from the moment you pick up your inhaler to the moment you put it down.

Mistake #1: Not Checking and Shaking Before Every Dose

Before you do anything else, take a quick check.

Once you take the lid off, look inside. Is there any dust or debris in there? Is it dirty? You don’t want to be breathing in foreign particles. Plus a blocked mouthpiece means you’re actually not getting any medication in.

You Need to Shake It

Shake it like a Polaroid picture. (That’s what I tell my kids.)

You need to shake it at least 10 to 15 times.

The reason: The medication and propellant separate. The solids drop to the bottom. It’s like when you have vanilla extract in your kitchen—the vanilla goes to the bottom and the alcohol goes to the top. If you don’t shake it before you measure it for your cookies, you’re just pouring alcohol and not getting any of the delicious vanilla.

You’ve got to shake it first. Same with your inhaler.

If you don’t shake it, you might only be getting the propellant (the stuff that makes it spray out quickly). You might not even get any medication at all.

What About Priming?

If your inhaler is brand new, if you haven’t used it in 7 days or more, or if you drop it, then you need to prime it.

After shaking it, spray it away from you (not towards you). This is just to get the propellant going. It’s not to help you yet.

Spray it away from you, shake it again, and spray it away from you a second time.

Check the package insert for your specific inhaler, because they’re all a little bit different in when priming is needed and how to prime it.

If you skip priming on that first dose, you’re probably just getting propellant into your mouth—not the medication your body needs.

Quick fix: Check and shake before every single dose.

Mistake #2: Wrong Body and Head Position

I know sometimes if you have asthma that gets bad when you’re sick, you might be in bed, hunched with a pillow behind you, curled into a recovery fetal position.

But if you don’t give your airway a straighter tube to go down, it’s less likely the medication will work properly.

If you’re curved, that makes it harder for the medication to go into your lungs.

If your head is level or even with a slight tilt upward, that gives the best aim for that medication powder to get down into your lungs.

You want:

Your chest open
Your shoulders rolled back a little bit

How Do You Hold It?

You want to hold it with the medication canister on top and the mouthpiece on the bottom.

Don’t spray it sideways. It’s not going to work properly. The canister needs to be on top.

Mistake #3: Poor Mouth Seal

An inhaler is not a throat spray.

With a throat spray, you have your mouth wide open because you’re trying to get the spray to the back of your mouth.

An inhaler is not meant to go on your throat—it’s meant to go in your lungs.

You need to create a perfect seal around the mouthpiece, or the medication powder can escape out the sides of your mouth where you’re not sealing it properly.

It needs to be a firm, airtight seal with no gaps in the corners.

Practice in the mirror if you need to. It should look and feel like a complete seal around the mouthpiece.

Mistake #4: Your Tongue or Teeth Are Blocking the Airway

Even if you have a perfect lip seal, if your teeth are in the way, powder can’t get past your big, shiny whites.

Your tongue needs to be flat—not curved, not doing other things. It needs to be laying flat as gently as possible.

Your teeth should be slightly apart, not clamped.

So: Inhaler in mouth, lip sealed, tongue and teeth in those positions.

It takes a little bit of getting used to, but it makes a real difference.

Mistake #5: Not Fully Exhaling Before You Inhale

This one’s easy to skip, but it matters more than most people realize.

Before you put your inhaler to your mouth, breathe out all the way.

You can even put your hand on your belly to push it in and make yourself think, “I’ve got to get that air out.”

Why? Because if your lungs are already partially full of air, there’s less space for the medication to go. You have less room to inhale deeply, and a shallow inhale means the medication just can’t get down to the lower airways where it needs to be.

Full exhale first, then lips-tongue-teeth, then press, then breathe in.

Mistake #6: Waiting to Breathe In Until After You Press the Button

This is probably the most common mistake I see.

It’s easy to make because it seems logical: Press the button, then breathe in.

But wrong.

Researchers at Rice University found that a delay of just half a second between pressing an inhaler and breathing in was enough to cut lung deposition by half—dropping it from around 35% to 20%.

A half a second. That’s all it takes to lose half of your dose.

Here’s the Exact Sequence the Research Recommends:

Start your breath in first, then about half a second into that inhalation, press the inhaler down.

Your breath is already moving when the medication releases, which carries it past your throat and deep into your airways.

Think of it like putting a little tiny sailboat on a river you’re making with your hose. If you put the boat down before you turn on the hose, it’s not going to be able to go anywhere. But if you start the river flowing and then put the boat on, it can sail smoothly down your little manmade river.

You need the flow happening so that when the medication comes, it knows exactly where to go.

So it’s not “press, then breathe.”

It’s not exactly simultaneous.

Breath starts first, and the press follows a half a second later.

This takes practice to get the timing right. But now you know exactly what you’re aiming for and why it matters so much.

Mistake #7: Inhaling Too Fast or Too Slow

You’ve got the timing down—you’re breathing in first, then pressing a half a second later. But how fast should that breath actually be?

This is a nuanced answer, because the instinct to inhale as hard and as fast as possible is actually wrong. But so is an extremely slow, leisurely breath.

The Rice University research found that the ideal inhalation is a deep, moderately high flow rate sustained over about 3 seconds.

You don’t want a sharp gasp that lasts one second or less. That will just send the medication crashing toward the back of your throat before it can travel deeper.

But if it’s too slow—a gentle creep—it won’t give enough acceleration to carry the medication deep into your lungs.

Think of it as purposeful and steady—deep, with some conviction to it, over about 3 seconds.

You should feel like you’re filling your lungs, not just your chest.

Then Hold It

Once you’ve inhaled your full dose, you’ve got to hold your breath for at least 10 seconds.

That gives the medication time to settle into the lining of your airways before you breathe it back out.

Ten seconds. I know it feels long, especially when you’re having an asthma attack, but do it anyway.

Mistake #8: Not Waiting Long Enough Between Puffs

Here’s one that, especially with albuterol, trips a lot of people up.

A study in the Journal of Allergy and Clinical Immunology found that 84% of inhaler users who needed multiple puffs did not wait long enough between inhalations. More than half didn’t even wait 15 seconds.

Again, it’s not like a throat spray where you go spray-spray.

The minimum wait time for an albuterol inhaler is actually 30 seconds.

The reason is straightforward: Each puff needs to be deposited before the next puff goes in.

If you fire the second puff too quickly, you’re essentially sending medication into areas that are already coated. Or if I were to show you a microscopic view, the second puff will actually mess up the aerodynamics of the first puff. You’ll actually get less medication from two puffs if you go puff-puff than if you’d just done one.

30 seconds between puffs.

Set a timer on your phone or watch if you need to. (“Hey Siri, set a timer for 30 seconds.”)

Most people dramatically underestimate how long 30 seconds is, especially when you’re mid-flare and you need relief fast. But rushing it means you’re not getting the full benefit of that second dose.

Mistake #9: Using an Empty Inhaler

Here’s a question: Are you sure there’s actually medication in your inhaler right now?

Many people use their inhaler all the way past empty and don’t even realize it.

One of the most persistent myths about inhalers is the float test—dropping your inhaler in a bowl of water to see if it sinks or floats.

Please stop doing this.

The float test only measures the amount of propellant remaining, not the medication itself. An inhaler can float and have zero medication in it. An inhaler can sink and be completely empty.

The float test is unreliable. Don’t use it.

The Only Reliable Method: The Dose Counter

Modern inhalers have a dose counter built in. Watch that number.

When it gets into the yellow zone, that’s when it’s time to reorder your prescription to get a refill.

When it’s in the red zone, that’s when it’s time to throw it away.

Using an empty inhaler during a flare is one of the most dangerous things, because you think you’re getting medication and you’re not. You’re getting nothing.

Mistake #10: Not Using a Spacer (or Using It Wrong)

A spacer—also known as a valved holding chamber—is a tube that attaches to your inhaler. It gives the medication time to slow down and decreases the amount that lands on your throat while increasing the amount that lands in your lungs.

A lot of patients have never heard of one, were never given one, or were given one and don’t know how to use it.

Why Spacers Matter

The spacer decreases the challenge of timing when you press and when you breathe. Especially with children, this really helps so they can get the medication they need without such a complicated technique.

The medication releases into the chamber and waits for you, so you can just breathe normally. You can leave it on your face for 30 seconds and breathe normally.

Something many people don’t know: A spacer reduces the amount of inhaled steroid that lands in your mouth and throat.

That matters because steroids depositing on these oral tissues can lead to mouth thrush—a yeast infection that’s painful, with little white plaques in your mouth. It requires treatment.

Common Spacer Mistakes

Not forming a complete seal – Whether it’s a face mask or a mouthpiece, you need a complete seal
Not cleaning it regularly – Powder can build up inside, and static electricity can make it stick to the edges instead of reaching you. Rinse it with warm water, let it air dry, and don’t rub it (rubbing increases static)

Preventing Thrush

When you have an inhaled steroid (whether with a spacer or without), be sure to rinse your mouth out or gargle and then spit to decrease your risk for thrush.

An easy way to remember: Use your inhaler right before brushing your teeth. You’re not going to swallow your toothpaste spit, so you’ll automatically be spitting out the liquid that comes in your mouth next.

Ask your pharmacist or doctor if a spacer’s right for you. For most people, the answer is yes.

Mistake #11: Using the Wrong Inhaler

I promised you at the beginning that this mistake has nothing to do with technique, and I meant it.

Because you can shake your inhaler perfectly, exhale fully, create a proper seal, have the timing precise—and yet be making the biggest inhaler mistake of all.

And that mistake is which inhaler you’re using.

The Guideline Shift You Need to Know About

When I was trained to be a pharmacist, the idea was: albuterol is your rescue inhaler that you use when you need it, and your controller inhaler is something else you use daily.

Well, there’s a new guideline that came out from GINA (the Global Initiative for Asthma), and now they divide asthma treatment into two tracks—and which track you’re on determines which inhaler should be your rescue medication.

What? I thought albuterol was the only rescue medication.

Not anymore.

Track 1: Symbicort for Both Maintenance and Rescue

Track 1 actually uses Symbicort (budesonide/formoterol) as both your daily maintenance inhaler and your rescue inhaler.

One inhaler, both jobs.

When you feel symptoms starting, you reach for Symbicort. On Track 1, there is no separate rescue inhaler. Symbicort handles everything.

Here’s Why This Matters

Albuterol (the classic rescue inhaler) is what’s called a bronchodilator. It opens your airways when they’re tightening. That’s helpful in the moment, but it does absolutely nothing for inflammation. It doesn’t address the inflammation that caused the problem in the first place.

Using albuterol alone during a flare is like throwing a small bucket of water on a raging inferno. It helps in the moment, but the fire’s still burning underneath. The inflammation is still there.

And when that inflammation keeps building unchecked, that’s when you end up with a serious flare—and a serious flare often ends up with a prednisone pill prescription and ongoing damage that is irreversible.

Symbicort, on the other hand, contains an inhaled corticosteroid (budesonide) alongside the bronchodilator (formoterol).

So when you take a rescue puff, you’re opening your airways and addressing inflammation at the same time. You’re not just putting out the visible flame—you’re working on the fire underneath too.

What About Track 2?

Track 2 still uses albuterol as a rescue inhaler, but it requires a separate inhaled corticosteroid inhaler alongside it.

Albuterol on Track 2 isn’t wrong, but albuterol with nothing else—no controller, no inhaled steroid—that’s the problem GINA is eliminating with this new guideline.

The mistake isn’t necessarily using albuterol. The mistake is using albuterol as your only inhaler, with nothing else managing the inflammation underneath.

Do Not Switch on Your Own

I want to be very clear: Do not throw away your albuterol and switch inhalers on your own.

This is a conversation to have with your doctor, but it is absolutely worth having.

If your doctor hasn’t mentioned the Track 1 option (where Symbicort handles both maintenance and rescue in a single inhaler), they may not know you’d be open to the conversation, or the guideline shift might not have reached their office yet.

Either way, you can be the one to bring it up.

Questions to Ask Your Doctor

Let’s make sure you leave today with the exact questions to ask your doctor:

Can you watch me use my inhaler right now and tell me if I’m doing it correctly?
Do I need to be using a spacer with my inhaler?
When should I replace my inhaler? How do I know when it’s actually empty?
Which track am I on for my asthma treatment, and am I a candidate for Track 1 with only Symbicort as both my maintenance and rescue inhaler?
If I’m currently using albuterol as my only rescue inhaler with no daily controller, should we be talking about updating my treatment plan?

Even Perfect Technique Can’t Always Prevent Prednisone

You now know the 11 mistakes, including the one your doctor may not have mentioned yet. You know the right technique from start to finish, and you have the exact questions to bring to your appointment.

But here’s the thing: Even with perfect inhaler technique, prednisone can still happen.

A bad infection, a stressful situation, surgery—there are lots of reasons someone ends up on prednisone.

If you’ve been using an inhaler for a while and you’ve still had asthma flares despite your best efforts, there’s a good chance you’ve been prescribed prednisone pills in the past.

And if that’s you, there’s something important you need to know: You don’t have to suffer from the side effects of this medication like you used to.

When I personally took prednisone, I discovered that there are ways to minimize the side effects by giving back what prednisone is stealing from your body.

That’s exactly why I created Nutranize Zone—the first and only supplement designed specifically for people on prednisone.

You just take 2 capsules in the morning and 2 capsules at bedtime along with your prednisone to help minimize the side effects so you can feel like yourself again while taking prednisone.

Learn more about Nutranize Zone here →

Free Download: Your Complete Inhaler Technique Checklist

I’ve put everything you need to master your inhaler technique into one printable, easy-to-follow checklist.

Here’s what’s inside:

✓ Step-by-step proper technique guide – From the moment you pick up your inhaler to the moment you put it down, with exact timing for each step

✓ All 7+ mistakes to avoid – Quick-reference checklist so you can spot what you might be doing wrong

✓ Questions to ask your doctor – The exact questions to bring to your next appointment, including asking about Track 1 vs. Track 2 treatment options

✓ Spacer usage guide – When to use one, how to use it correctly, and how to clean it properly

✓ Printable format – One page you can keep by your inhaler or take to your doctor’s appointment

This isn’t just another handout. This is the distilled knowledge from pulmonary medicine training, clinical databases, and years of helping patients avoid the prednisone prescription they don’t want.

Print it out. Keep it by your inhaler. Take it to your next appointment. Use it every time you use your inhaler until perfect technique becomes automatic.

Your asthma control—and your ability to avoid prednisone—depends on getting this right.

References:
Rice University News. (2017, February 28). Inhaler study: How much medicine makes it to lungs? https://news2.rice.edu/2017/02/28/inhaler-study-how-much-medicine-makes-it-to-lungs/
American Academy of Allergy, Asthma & Immunology (AAAAI). SMART Therapy for Asthma. https://www.aaaai.org/tools-for-the-public/conditions-library/asthma/smart
Dubin S, Patak P, Jung D. (2024). Update on Asthma Management Guidelines. Missouri Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC11482852/