Asthma Inhalers:


Asthma Inhalers


Inhaled Corticosteroids

To treat inflammation part of asthma (swelling of the airways).  This is the underlying part of asthma that causes the bronchoconstriction of the airways which in turn lead to symptoms of shortness of breath, coughing, chest tightness and wheezing.

1. Asmanex 110mcg or 220 mcg Twisthaler (mometasone)

2. Flovent Diskus 50 mcg,100mcg, 200mcg (fluticasone)

3. Flovent HFA 44 mcg, 110mcg, 220mcg (fluticasone)

4. Pulmicort Flexhaler 90 mcg, 180 mcg (budesonide)

5. Qvar HFA 40 mcg, 80 mcg (beclomethasone)

6. Azmacort (triamcinolone)

7. Alvesco 80 mcg, 160mcg (ciclesonide)



Combination Medications 

Contain both long-acting bronchodilator and inhaled corticosteroid components to treat both inflammation and bronchoconstriction.

1. Advair Diskus 100/50, 250/50, 500/50 (fluticasone/salmeterol)

2. Advair HFA 45/21, 115/21, 230/21 (fluticasone/salmeterol)

3. Symbicort HFA 80mcg/4.5, 160/4.5 (budesonide(Pulmicort)/formoterol(Foradil)

4. Dulera 100/5, 200/5 (Asmanex/Foradil)



Using a Metered Dose Inhaler

Albuterol, ProAir, Proventil, Ventolin, Xopenex, Combivent, Flovent HFA, Symbicort HFA, QVAR, Advair HFA, Alvesco, Dulera


1. Shake well before using because the medication is mixed with an aerosol propellant and if not shaken up and mixed, the correct dosage of medication will not be delivered.

2. Have pt. exhale completely.

3. Place mouthpiece of inhaler in mouth and close lips around tightly making sure tongue is not blocking opening of the mouthpiece.

4. Have pt. start to breathe in through mouth, while pressing down firmly on the canister with finger.

5. Continue to take that same full deep breathe in after medication is delivered.

6. Try to hold that breathe in for 10 seconds.

7. If the medication is a corticosteroid, have pt. rinse mouth after each use.

If a second puff is ordered, try to wait about 30 – 60 seconds after the first puff and shake inhaler between doses.



Using Dry Powder Inhalers (DPI)

To use Flovent Diskus, Serevent Diskus, Advair Diskus:


1. Open the diskus by holding it in one hand and put the thumb of the other hand in thumb grip.  Push your thumb away from you as far as it will go until the mouthpiece appears and snaps into position.

2. Hold the discus in a level, flat position with the mouthpiece towards you.  Slide the lever away from you as far as it will go until it clicks.

3. Keep the discus level, do not tilt.

4. Have patient exhale completely.

5. Place mouth over mouthpiece tightly making sure tongue is not blocking, take a deep breath and hold it for 10 seconds.

6. Most patients can feel or taste the powder on the back of their tongue which is normal.

7. Close disk and it is ready for next use.

8. Be sure to rinse mouth after each use.



To use Asmanex Twisthaler


1. It is important when that you remove the cap of the Twisthaler while it is in upright position to make sure the right amount of medication is delivered with each dose.

2. Twist the cap in a counterclockwise direction to remove it.  As you lift off cap, the dose counter on the base will count down by one.  This loads the medication and it is  ready for use.

3. Have patient exhale completely.

4. Place mouthpiece in mouth and close lips around firmly and take a deep forceful breath in and hold for 10 seconds. Remove mouthpiece BEFORE exhaling.

5. Be sure to not cover the ventilation holes while inhaling the dose.

6. Replace cap.  You will hear a click to let you know that the cap is firmly closed.

7. Repeat steps for the second dose.

8. Be sure to have patient rinse mouth with water after dose and spit out.  Do not swallow.




To use Pulmicort Flexhaler


1. Twist and lift cover off while holding in an upright position.

2. Twist the brown grip fully in one direction as far as it will go. 

3. Twist it fully back again in the other direction as far as it will go and you will hear a click.

4. Have patient turn head away form the inhaler and exhale completely.

5. Place mouthpiece in mouth, and inhale deeply and forcefully through the inhaler and hold breath for 10 seconds.  Remove mouthpiece BEFORE exhaling.

6. Place cover back on the inhaler and twist shut.

7. Rinse mouth with water after use and spit out.  Do not swallow if possible.



Using a spacer with MDI’S

Spacers are useful for all patients to ensure they are getting all of the medication.  They are particularly recommended for young children and older adults but everyone can benefit from using a spacer since using an MDI takes a lot thought and coordination.

1. Be sure to make sure the mask has a good seal around the patient’s mouth and nose.


2. Have the patient exhale while mask/spacer is on mouth.

3. Press down on inhaler to release medication and have patient take 5 deep breathes in and out.  You should notice the exhalation valve on the spacer moving in and out to  ensure they are taking a deep enough breath.

4. Have patients rinse mouth with water and spit out after using steroid containing medications.

5. Spacers should be rinsed out with normal soap and water and let air dry weekly.