Breath of Fresh Air: Feature Articles

Chapter 36: How long do I need to wait between "puffs" from my inhaler?

If you use your inhaler properly, shaking before its use, slowly breathing in after activating the inhaler, and holding your breath for about five seconds after each spray, then the answer to the question is not at all. After you have completed one careful inhalation, you (and your inhaler) are ready for the next "puff."

If you were to use your inhaler several times in rapid succession, without any pause between "puffs," it might begin to deliver medication erratically. Due to evaporation, cooling takes place at the metal nozzle of the canister, possibly interfering with its precise functioning and exact delivery of the same amount of medication each time. However, with slow, careful inhalations followed by brief breathholding, enough time elapses between puffs to prevent any problems. There is no justification for the recommendation to wait one full minute between inhalations. No benefit derives from delaying one minute before taking the next "puff" from your metered-dose inhaler, only added frustration and impatience with your medications.

In the past many doctors recommended that before using your antiinflammatory (corticosteroid) inhaler, you should first take two puffs from your bronchodilator (beta-agonist) inhaler. The rationale was that the bronchodilator would first open the bronchial tubes, allowing the inhaled antiinflammatory medication to penetrate through the bronchial tubes deeper into the lungs. At the Asthma Center we no longer make this our routine recommendation. For one thing, you would have to wait 5-10 minutes or more for the beta-agonist bronchodilator (an example of which is albuterol) to work fully before continuing with your antiinflammatory inhaler. For most people, this delay would be very impractical; time is too precious to wait between doses of medications. For another thing, in most circumstances the bronchial tubes are sufficiently wide open to permit delivery of the antiinflammatory medication without any need for pre-treatment with a bronchodilator. We have come to see the role of the beta-agonist bronchodilators as treatment "as needed" for quick relief of asthma symptoms — your "reliever" medication. There is no need for you to use it on any regular basis (with the exception of very long-acting beta-agonist bronchodilator, salmeterol - brand name, Serevent®).