Asthma is one of the most common chronic conditions in pediatrics, and inhaled medications are at the heart of effective management. But here’s the twist: even when we prescribe the right drug at the right dose, if the inhaler technique is off, the benefits can vanish in a literal puff of air.
Poor inhaler technique in kids is common, under-recognized, and hugely consequential. The good news? Most errors are fixable with a little time, patience, and education. Here's how to spot them and what we can do to help.
Even when kids have the right medication, using it incorrectly can render it ineffective. Inhalers are only as good as their delivery — if medication lands on the tongue or spacer walls instead of in the lungs, asthma control suffers. That means more flares, more missed school days, more ER visits.
And yet, many children (and their caregivers) don’t realize they’re doing anything wrong. One study found that over 50% of pediatric patients used their inhalers incorrectly, and many hadn’t been shown the correct technique since their first prescription.
Error 1: Skipping the Shake and Prime
What goes wrong: With metered-dose inhalers (MDIs), medication is mixed with a propellant (typically hydrofluoroalkane, or HFA). If not shaken or primed, the child might inhale mostly propellant and very little medication.
How to fix it:
Error 2: Poor Timing Between Actuation and Inhalation
What goes wrong: MDIs require pressing the canister right as the child starts to inhale. A delay of even a second can cause the medication to land on the tongue or into the air.
How to fix it:
Error 3: Inhaling Too Quickly or Too Shallowly
What goes wrong: Some children breathe too fast or too shallowly, or don’t inhale at all before removing the device. Dry powder inhalers (DPIs), in particular, require a strong, fast inhalation to deliver the medication properly.
How to fix it:
Error 4: Not Rinsing After Inhaled Steroid Use
What goes wrong: Inhaled corticosteroids left in the mouth can cause oral thrush or hoarseness.
How to fix it:
Error 5: Drying Spacers with a Towel
What goes wrong: Towel-drying spacers or face masks generate static electricity, which causes medication particles to stick to the plastic. That means less medication actually reaches the lungs.
How to fix it:
Error 6: Not Reviewing Technique at Follow-Up
What goes wrong: Even if the technique was perfect at the initial visit, it often drifts over time—especially for kids who are growing, switching devices, or using them infrequently.
How to fix it:
Repetition and modeling matter: Have the patient demonstrate inhaler technique at every visit. Ask, “Can you show me how you use your inhaler at home?”
Use age-appropriate tools: Spacer with well-fitting mask for toddlers, spacer with mouthpiece for older kids, DPI for teens (if appropriate, and their technique is adequate).
Involve caregivers: Make sure parents feel confident enough to teach and correct their child at home.
Mastering pediatric inhaler technique doesn’t require fancy equipment or hours of instruction. Most errors can be corrected in under five minutes—with an encouraging tone and a little hands-on support. And the payoff? Better asthma control, fewer symptoms, and more confident families.
Because when we help a child get their inhaler technique right, we’re not just improving lung function, we’re helping them sleep through the night, run at recess, and live with fewer limitations.
Let’s make sure every puff counts.