Studies consistently show that roughly half of inhaler users do not use their device correctly, and poor technique can cut the amount of medication reaching your lungs by more than 50 percent. The good news: your Edmonton pharmacist can watch you use your inhaler, correct your technique on the spot, and even prescribe asthma medications for mild cases under Alberta's expanded scope of practice. Here is everything you need to know about your inhaler, from the type in your hand to the triggers outside your door.
Rescue inhalers vs. controller inhalers
Not all inhalers do the same job. Understanding the difference between your rescue inhaler and your controller inhaler is the single most important thing you can do for your asthma management.
Rescue inhalers (relievers)
Rescue inhalers contain a fast-acting bronchodilator, most commonly salbutamol (sold as Ventolin or the generic equivalent). They work within minutes by relaxing the muscles around your airways, opening them up so you can breathe. You use a rescue inhaler only when you have symptoms: wheezing, chest tightness, shortness of breath, or coughing.
Think of your rescue inhaler as a fire extinguisher. It puts out the fire, but it does nothing to prevent the next one. If you are reaching for your rescue inhaler more than two or three times a week (outside of exercise), your asthma is not well controlled and you likely need a controller medication.
Controller inhalers (preventers)
Controller inhalers are used every day, whether you feel symptoms or not. They reduce inflammation in your airways over time, making flare-ups less likely and less severe. The main categories are:
- Inhaled corticosteroids (ICS). Fluticasone (Flovent), budesonide (Pulmicort), and ciclesonide (Alvesco). These are the foundation of asthma control for most people.
- Combination inhalers (ICS + long-acting bronchodilator). Budesonide/formoterol (Symbicort), fluticasone/salmeterol (Advair), and fluticasone/vilanterol (Breo Ellipta). These combine daily anti-inflammatory medication with a long-acting bronchodilator for patients who need more than an ICS alone.
Controller inhalers do not provide instant relief. They work gradually over days to weeks. The most common mistake patients make is stopping their controller because they feel fine. Feeling fine is the proof the controller is working. Stopping it invites the inflammation back.
Types of inhaler devices
The medication matters, but so does the device that delivers it. The two most common types in Canada are metered-dose inhalers and dry powder inhalers, and each requires a different breathing technique.
Metered-dose inhalers (MDIs)
An MDI is the classic pressurized canister in an L-shaped plastic holder. It releases a measured spray of medication when you press the canister down. Ventolin, Flovent, and Alvesco are dispensed as MDIs.
MDIs require coordination: you need to press the canister and breathe in at the same time, slowly and steadily. This is where most technique errors happen, and it is why spacer devices exist (more on that below).
Dry powder inhalers (DPIs)
DPIs deliver medication as a fine powder that you inhale with a quick, deep breath. There is no propellant and no need to coordinate pressing and breathing. Common DPIs include the Turbuhaler (Symbicort, Pulmicort), the Diskus (Advair, Flovent Diskus), and the Ellipta (Breo Ellipta).
The key difference: DPIs require a fast, forceful inhalation to pull the powder deep into your lungs. Breathing slowly (the correct technique for an MDI) will leave most of the powder sitting in your mouth and throat.
Proper inhaler technique, step by step
Getting the technique right is not optional. It is the difference between medication reaching your lungs and medication coating the back of your throat.
MDI technique (with or without spacer)
- Shake the inhaler well for 5 seconds. The medication and propellant separate when the inhaler sits unused.
- Breathe out fully away from the inhaler, emptying your lungs as much as comfortable.
- Seal your lips around the mouthpiece (or the spacer mouthpiece).
- Press the canister and breathe in slowly and steadily for 3 to 5 seconds. If using a spacer, press first and then breathe in within 1 to 2 seconds.
- Hold your breath for 10 seconds (or as long as comfortable) to let the medication settle in your airways.
- Wait 30 to 60 seconds before taking a second puff if prescribed.
DPI technique (Turbuhaler, Diskus, Ellipta)
- Load the dose according to the device instructions (twist the base for Turbuhaler, slide the lever for Diskus, open the cover for Ellipta).
- Breathe out fully away from the device. Never exhale into a DPI as moisture from your breath can clump the powder.
- Seal your lips around the mouthpiece.
- Breathe in fast and deep, as hard as you can, for 2 to 3 seconds.
- Hold your breath for 10 seconds.
- Close the device properly to protect the next dose from humidity.
The five most common inhaler mistakes
Your pharmacist sees these errors every day. Any one of them can significantly reduce the medication you actually receive.
- Not shaking the MDI. The active ingredient settles to the bottom. Without shaking, the first few puffs deliver mostly propellant.
- Breathing too fast with an MDI. A fast, sharp breath sends the medication crashing into the back of your throat instead of carrying it deep into your lungs. Slow and steady is correct for MDIs.
- Breathing too slowly with a DPI. The opposite problem. DPIs need a fast, forceful breath to break up the powder and pull it into your airways.
- Not using a spacer with an MDI. Without a spacer, coordinating the press-and-breathe is difficult, and much of the spray hits your tongue and throat. A spacer holds the mist in a chamber so you can breathe it in at your own pace.
- Forgetting to rinse your mouth after a corticosteroid inhaler. Inhaled corticosteroids (Flovent, Symbicort, Advair, Breo) that deposit in your mouth and throat can cause oral thrush (a yeast infection) and hoarseness. Rinsing your mouth with water and spitting it out after each dose prevents this.
Spacer devices: when and why you need one
A spacer is a plastic chamber that attaches to the mouthpiece of your MDI. It holds the medication mist for a few seconds, giving you time to breathe it in without needing perfect press-and-breathe coordination.
Spacers are recommended for:
- Children under 12 using any MDI
- Adults who have difficulty coordinating the press-and-breathe technique
- Anyone using an inhaled corticosteroid MDI (to reduce throat deposition and thrush risk)
- People who find they cough or gag when using an MDI directly
Using a spacer with an MDI can increase the amount of medication reaching your lungs by up to 20 percent. We carry spacers at Acme Drug Mart and can fit one to your inhaler during your visit.
Your Edmonton pharmacist can prescribe for asthma
Under Alberta's expanded pharmacist scope of practice, your pharmacist can do more than dispense inhalers. For mild, stable asthma, an Alberta pharmacist can:
- Prescribe a rescue inhaler (salbutamol) when you need one and cannot get a doctor's appointment in time
- Renew existing asthma prescriptions so you do not go without your controller medication while waiting to see your physician
- Assess your inhaler technique and correct errors on the spot, using a placebo device so you can practise
- Review your asthma control by asking structured questions about symptom frequency, rescue inhaler use, and nighttime waking
- Recommend a step up or step down in therapy and communicate with your prescribing physician
These services are available at Acme Drug Mart with no appointment required. If you are unsure whether your asthma is well controlled, walk in and ask.
When to see a doctor
Your pharmacist is the right first stop for prescription renewals, technique checks, and mild symptom management. But certain situations require a physician or specialist referral:
- You are using your rescue inhaler more than three times a week (outside of exercise)
- You wake up at night due to asthma symptoms more than once a week
- You have visited an emergency department or urgent care for asthma in the past year
- Your symptoms are getting worse despite using your controller inhaler correctly every day
- You have had a course of oral prednisone for asthma in the past 12 months
- You are not sure what triggers your asthma or have never had formal allergy testing
Your pharmacist can help you recognize these warning signs and will refer you to a physician when the situation calls for it.
Edmonton-specific asthma triggers
Edmonton's climate and geography create a unique set of asthma triggers that change with the seasons. Being aware of them helps you plan ahead and adjust your medication if needed.
Wildfire smoke (summer)
Edmonton's summers increasingly bring wildfire smoke from northern Alberta and British Columbia. Fine particulate matter (PM2.5) from smoke is a potent asthma trigger. On heavy smoke days, the Air Quality Health Index (AQHI) can climb above 7 or 8, and anyone with asthma should limit outdoor activity, keep windows closed, and consider running an air purifier with a HEPA filter. If you notice increased rescue inhaler use during smoke season, talk to your pharmacist about temporarily stepping up your controller dose.
Cold, dry air (winter)
Edmonton winters routinely bring temperatures below minus 20 C. Breathing in cold, dry air can trigger bronchoconstriction, the tightening of airway muscles that causes wheezing and shortness of breath. Wearing a scarf or cold-weather mask over your nose and mouth warms and humidifies the air before it reaches your lungs. Using your rescue inhaler 10 to 15 minutes before going outside in extreme cold can also help.
Pollen seasons (spring and fall)
Tree pollen (birch, poplar, elm) peaks in Edmonton from late April through June. Grass pollen follows in July. Ragweed and other weed pollens appear in August and September. If pollen is a trigger for your asthma, your pharmacist can recommend an antihistamine or nasal corticosteroid to use alongside your asthma medications. Treating the allergy component often improves asthma control significantly.
Indoor triggers year-round
Edmonton homes are sealed tight for winter, which concentrates indoor allergens: dust mites, pet dander, mould, and cooking fumes. If your asthma is worse indoors during winter, consider HEPA filtration in the bedroom, encasing pillows and mattresses in allergen-proof covers, and keeping humidity between 30 and 50 percent to discourage mould and dust mites.
Walk in
(780) 443-0202. Unit 103, 15508 87 Ave NW, Meadowlark Place, Edmonton. Open Monday 9 to 5, Tuesday through Friday 9 to 6, Saturday 11 to 5. No appointment needed for inhaler technique assessment or prescription renewal.