What are the proper directions for using an albuterol (bronchodilator) inhaler?

Albuterol Inhaler Use Instructions

For routine symptom relief, take 1-2 puffs every 4-6 hours as needed, but if you're using your rescue inhaler more than twice weekly for symptom control (excluding exercise prevention), your asthma is poorly controlled and requires controller medication adjustment. 1, 2

Standard Dosing for Symptom Relief

Metered-Dose Inhaler (MDI) Technique:

• Shake the inhaler vigorously for 5 seconds immediately before each use 3
• Actuate the inhaler within seconds of shaking—if you delay more than 30 seconds, re-shake the canister before use, as delays can alter the delivered dose 3
• Take 1-2 puffs (90 mcg per puff) every 4-6 hours as needed for symptom relief 1, 2
• If taking multiple puffs, space them 10-15 seconds apart; longer intervals offer no additional benefit 1
• Use a spacer or valved holding chamber with your MDI—this improves drug delivery and reduces side effects 1

Important caveat: The hydrofluoroalkane (HFA) propellant inhalers have a different spray "feel" than older inhalers, but deliver equivalent medication despite patients' concerns 1.

Acute Symptom Worsening (Yellow Zone)

When experiencing increased cough, wheeze, chest tightness, or shortness of breath:

• Take 4-8 puffs every 20 minutes for up to 3 doses (first hour) 4, 2
• After the first hour, continue 4-8 puffs every 1-4 hours as needed based on symptom response 4, 2
• Each puff should be taken sequentially with proper inhalation technique 1

Critical point: Two puffs from an MDI are NOT equivalent to a nebulizer treatment—you need 6-10 puffs from an MDI with spacer to match nebulizer effectiveness 1.

Proper Inhalation Technique

Step-by-step process (have your physician observe and regularly review your technique, as most patients use inhalers incorrectly): 1

1. Remove the cap and shake the inhaler vigorously for 5 seconds 3
2. Attach spacer/valved holding chamber if using one (strongly recommended) 1
3. Exhale completely away from the device
4. Place mouthpiece in mouth or hold spacer to lips with tight seal
5. Begin slow, deep inhalation and actuate the inhaler once
6. Continue inhaling slowly and deeply
7. Hold breath for 10 seconds if possible
8. Wait 10-15 seconds before next puff if multiple puffs needed 1

Red Flags Requiring Medical Attention

Seek immediate medical care if: 2, 5

• You're using rescue medication more frequently without relief
• You need increasing doses to achieve the same effect (indicates worsening asthma control) 1, 2
• You experience very severe shortness of breath, inability to speak, or altered mental status 4
• Symptoms persist or worsen despite appropriate rescue medication use 1

Exercise-Induced Symptoms

• Take 2 puffs 15-30 minutes before anticipated exercise or exposure to known triggers 1
• This preventive use does NOT count toward the "twice weekly" threshold for poor control 1

Common Side Effects to Monitor

Expected dose-related effects include: 1, 4

• Rapid heartbeat (tachycardia)
• Skeletal muscle tremor
• Nervousness or jitteriness
• Headache

These effects are generally mild with inhaled use and much less prominent than with oral or nebulized forms 6. However, monitor for these symptoms, especially with frequent or high-dose use 4, 2.

Storage and Maintenance

• Store between 36-77°F (2-25°C) 7
• Keep track of doses used—most inhalers contain 200 doses 1
• Prime new inhalers according to manufacturer instructions 1
• Clean the actuator periodically as medication can plug the orifice 1

Critical Pitfall to Avoid

The most important mistake patients make is using rescue medication regularly instead of recognizing poor asthma control. If you're using albuterol more than twice weekly for symptom relief (not counting pre-exercise use), you need to contact your physician about starting or adjusting controller medications like inhaled corticosteroids 1, 2. Regular rescue inhaler use beyond this threshold indicates your asthma is inadequately controlled and puts you at risk for exacerbations.