An inhaler is a small device designed to deliver medication directly into the lungs for quick action on the airways. When an inhaler feels ineffective, it is often due to improper user technique, the physical condition of the device, or a change in the underlying medical condition. Systematically addressing these possibilities is the most effective way to restore the expected therapeutic effect.
Improper Usage Technique
The most common reason an inhaler seems ineffective is improper technique, which prevents the medicine from reaching the lower airways. Technique differs significantly between Metered-Dose Inhalers (MDIs) and Dry Powder Inhalers (DPIs). An MDI releases a propelled spray, requiring the user to inhale slowly and deeply to draw the medicine into the lungs. A DPI delivers a fine, dry powder, requiring a very fast and forceful inhalation to pull the medication out of the device.
A frequent error with MDIs is poor coordination between pressing the canister and starting the breath, known as hand-breath discoordination. If the puff is actuated too early or too late, the medication deposits on the back of the throat. Another common mistake for MDIs is failing to “prime” a new device or one that has not been used for several days. Priming involves spraying test puffs into the air to ensure the medicine and propellant are properly mixed and ready to deliver an accurate dose.
Regardless of the inhaler type, two breathing errors reduce effectiveness: not exhaling completely before use and not holding the breath afterward. Exhaling fully creates space for a deeper intake. Holding the breath for about ten seconds allows the particles to settle in the lungs. Additionally, a poor seal around the mouthpiece allows medication to escape into the air.
Checking the Inhaler’s Integrity
If technique is correct, check the physical state and supply of the device. Many modern inhalers have a dose counter that clearly displays the number of remaining doses. For older MDIs lacking a counter, the user must manually track actuations based on the total doses printed on the label. The unreliable “water float test” is discouraged because it is inaccurate with newer propellants and can damage the canister’s valve.
Residue buildup is a common physical problem, especially with MDIs, as medication can clog the small spray hole in the plastic actuator. Cleaning the actuator is a necessary maintenance step. Remove the metal canister and rinse the plastic casing under warm running water for about 30 seconds. Let the actuator air dry completely before reinserting the canister, as moisture contributes to clogging. Always check the expiration date, as potency decreases over time, and improper storage can compromise effectiveness.
When Your Condition Has Worsened
Sometimes, the inhaler works perfectly, but the medication is no longer adequate to manage symptoms, signaling a change in the underlying respiratory condition. Increased frequency of rescue inhaler use, such as albuterol, suggests that airway inflammation has worsened. Even perfectly delivered rescue medication cannot overcome a severe exacerbation or significant disease progression.
Heavy reliance on a short-acting bronchodilator can lead to tolerance (tachyphylaxis), reducing the drug’s duration of action. This means the effect may not last as long, prompting more frequent use. Needing a rescue inhaler more than twice a week often indicates the patient requires a stronger “controller” medication, typically an inhaled corticosteroid, to reduce chronic inflammation. A new treatment plan must be discussed with a healthcare provider to match the medication regimen to the current severity of the condition.
Recognizing a Medical Emergency
While troubleshooting technique and device integrity is important, certain symptoms require immediate medical attention regardless of the inhaler’s status. Signs of severe respiratory distress include extreme difficulty speaking in full sentences or an inability to speak. A bluish tint around the lips or fingernails indicates the body is not receiving enough oxygen.
Other immediate red flags are rapid, labored, or shallow breathing, or feelings of confusion or dizziness. If breathing deteriorates quickly, or if severe distress persists despite using a rescue inhaler, call emergency services immediately. Call for emergency transport and keep the patient calm and seated upright until help arrives.