This article will provide 8 recommendations for effective patient education regarding inhaled medications used in treating/preventing asthma symptoms and flare-ups.


By Bill Pruitt, MBA, RRT, CPFT, FAARC 


Asthma affects some 300 million people globally with around 1,000 deaths per day, mostly in low- and middle-income countries, with most of the deaths being preventable.1 According to the Centers for Disease Control and Prevention (CDC), approximately 26.8 million Americans (8.2% of the population) had current asthma in 2022, including about 4.5 million children younger than 18 years (6.2%).

Asthma pharmacotherapy is critical to managing disease and controlling symptoms, but patients face barriers to self-care, including a lack of education regarding correct inhaler technique, complexity and variation in inhaler devices, and poor adherence to prescribed medications.8 Patient factors such as treatment acceptance, self-efficacy, fear of side effects, and perceived benefits affect asthma medication adherence,9 and should be considered when developing an education plan. 

This article will describe 8 recommendations for providing effective patient education regarding inhaled medications used in treating/preventing asthma symptoms and flare-ups.

1. Teach the Basics of Asthma


The foundation for all aspects of asthma education is built on an understanding of the disease. Education is essential for patients using inhalers and nebulizers because proper medication administration directly affects symptom control, prevention of exacerbations, and overall quality of life. Studies have shown that incorrect inhaler technique is common among both children and adults and can significantly reduce medication delivery to the lungs, leading to poor asthma control, increased emergency department visits, and higher healthcare costs. Education provided by healthcare professionals helps patients and caregivers understand the purpose of controller versus rescue medications, recognize worsening symptoms, and use devices correctly and consistently.

For pediatric patients, caregiver involvement and repeated demonstration of inhaler or nebulizer technique are especially important because younger children may have difficulty coordinating inhalation or maintaining adherence to therapy. Teaching strategies such as return demonstrations, written asthma action plans, and routine reassessment of technique can improve medication adherence and reduce asthma-related complications. In addition, patient education promotes confidence in self-management, encourages trigger avoidance, and supports early intervention during asthma flare-ups, ultimately improving long-term respiratory outcomes.

Education should be provided for the patient, family, and caregivers. It is important to develop a partnership between healthcare provider and patient, in order to create a personalized asthma plan for self-management. The provider should encourage a continuing process for education and to support adherence, taking into consideration the patient’s level of health literacy.1 

Discussions should include the patient’s expectations, fears, and concerns, and the partnership should support the development of shared goals for self-management. Topics should include information on making an asthma diagnosis, asthma pathology – including airway inflammation, the presence of increased airway sensitivity to a number of triggers, and how asthma involves temporary airflow obstruction leading to breathing difficulty.1 

The patient should know about preventing asthma flare-ups, understand how to recognize when asthma is getting worse (self-monitoring) and how to respond (self-management).1 Education and follow-up should be included in each patient encounter.

2. Teach Classifications, Actions, & Effects of Inhaled Medications


Inhaled medications for asthma fall into two major categories: reliever medications and controller medications. All patients should have a reliever inhaler for as-needed use to treat break-through symptoms (and for use prior to exercise to avoid exercise-induced bronchospasm). It is important to note that experts no longer recommend using short-acting beta2-agonists (SABAs) alone as reliever medications. A combination of SABA + an inhaled corticosteroid (ICS) or ICS+ long-acting beta2-agonists (LABA) has become the best choice for reliever medications according to the evidence. A low-dose ICS-formoterol formulation has been recommended as the best combined reliever.1 The American Lung Association offers an excellent chart that shows images of a multitude of inhalers, the categories (quick reliever, long-acting, etc), the trade and generic names, definitions of terms, and add-on medications used in asthma (and includes medications for COPD).3 

Controller medications (also referred to as maintenance medications) contain an ICS in low, medium, or high dose formulations combined with a LABA (preferred) or a SABA. These medications are used to reduce airway inflammation, control symptoms, and reduce the risk of exacerbations. Controller medications are to be used on an on-going, regular basis even when symptoms are not present to provide maintenance therapy. Inhaled controllers include ICS, ICS-LABA, and ICS-LABA + long-acting muscarinic antagonists (LAMA).1-2 

The reliever medications (beta2-agonists) target the bronchial smooth muscles to relieve bronchoconstriction and its symptoms (shortness of breath, chest tightness, wheezing). SABA medications (ie, albuterol) last some 4 to 6 hours and have a rapid onset. LABA medications (ie, formoterol) last 12 to 24 hours and may also have a rapid onset to relieve symptoms from bronchospasm. Controller medications (specifically ICS) relieve inflammation, reduce bronchial hyperresponsiveness (less “twitchy” airways) and reduce the symptoms related to inflammation (coughing, mucus production, and shortness of breath, chest tightness, wheezing). Use of high-dose ICS can increase risk of pneumonia , and any dose of ICS can cause oral candidiasis (a fungal infection) particularly if inhaler technique is improper, or the patient does not “rinse and spit” after taking an ICS.1-2

3. Teach Inhaler Technique, Self-delivery, & How to Prime Inhalers


There are a number of inhaler devices and different approaches to producing an aerosol for inhalation (ie, pressurized metered-dose inhalers (MDI), dry-powder inhalers (DPI), and soft-mist inhalers (SMI).2 Some medications are available in several different devices, calling for different inhaler techniques depending on the device. It is vitally important for the healthcare team to be familiar with the specific inhaler techniques for each medication to properly instruct the patient about self-administration in order to get maximum drug delivery to the lower airways. Drug inserts provide these details in every new medication package, or they can be accessed online.

The AARC’s Patient’s Guide to Aerosol Medication Delivery also provides the details on many of the prescribed medications and inhalers.2 Each inhaler has instructions on the timing of actuation (if needed, some are actuated automatically and triggered by inspiratory flow), inspiratory flow (some need a slow flow, some call for quicker flow), and the need to shake the inhaler prior to administration (not all inhalers need to be shaken). A breath hold after full inspiration helps in drug deposition and is described in the package insert. These details must be taught, and the patient’s performance should be observed and reviewed at subsequent visits to check for understanding and proper performance. 

Some devices can improve deposition when combined with a valved holding chamber (VHC) or spacer, but some inhalers (DPI, SMI) are not suitable for using these supportive add-ons.2 In addition, some patients may not be able to perform the proper technique to use an inhaler due to the need for proper timing or adequate inspiratory flow. It is important that the prescriber and the HCW providing patient instruction are aware of patient limitations and recognize when a certain device may be more appropriate. Priming involves actuating the device into the air without inhaling the medication and is often called for in using a new MDI before the first dose is administered, or if the MDI has been sitting without use for a period of time, or if the MDI has been dropped. Not all MDIs call for priming but in those that call for this action, lack of priming can reduce the amount of medication released in the actuation for inhalation. More priming details are found in the product insert or in the AARC Patient Guide.2 

4. Teach Proper Technique for Using Handheld Nebulizers (and Portable Air Compressors)


Handheld nebulizers (HHN) are sometimes referred to as a small volume nebulizer (SVN) and use liquid medication (often in a unit-dose package) and are connected to a portable air compressor to produce the aerosol for inhalation. Some devices may use ultrasonic energy in sound waves to produce the aerosol, other devices may use a vibrating mesh, and these devices are battery operated. 

Patients need to know how to assemble the circuit, instill the medication, check and change the batteries (if appropriate), and how to operate and care for the air compressor (if applicable). Inhalation technique may differ from one device to another but usually involves a slow deep inhalation followed by a breath-hold prior to exhalation. Again, the details about using HHNs and compressors, ultrasonics, or vibrating mesh devices can often be found in the package insert, or in the AARC guide.2

5. Teach About Cleaning/Assembly Routines for HHN, MDI, DPI, and SMI Devices


Proper cleaning of aerosol therapy devices reduces the risk of infection and helps ensure that the device is not clogged or not functioning properly. Patients need to know how to clean and assemble the device(s) that have been prescribed. There are three primary types of asthma inhalers: metered-dose inhalers (MDIs), dry powder inhalers (DPIs), and soft mist inhalers (SMIs), and each requires different cleaning methods.10 MDIs should be disassembled and cleaned with water weekly, while DPIs and SMIs should have their mouthpieces wiped with a dry or damp cloth once a week to maintain cleanliness and proper function. Spacers and holding chambers should also be cleaned regularly as part of inhaler maintenance. Some spacers may be dishwasher-safe, but patients should always follow the manufacturer’s cleaning recommendations to avoid damaging the device. MDI, DPI, and SMI devices will have this information provided in the package insert.10 Cleaning and assembly, and when to replace a HHN, are described in the AARC Patient Guide.2

6. Discuss Asthma Action Plans, Medication Self-management, and When to Call for Help


Asthma Action Plans (AAP) are a written, one-page, patient-specific guide that provides a quick reference for patients to know how to monitor symptoms, what medications they are taking for controlling symptoms and for quick-relief of a flare up of symptoms, when to alter their usual routine/medications to address an asthma flare-up (i.e., stepping up and stepping down with their medications), and when (and who) to call for help if they are not getting relief from symptoms. A new, revised AAP should be provided to the patient if there is a change in their medications and all AAPs should be reviewed with the patient to ensure understanding of how to follow them. There are many samples/templates for AAPs on-line (see the GINA reference for sources).1

7. Provide Reliable, Evidence-based Asthma Resources


Many professional organizations provide valuable patient education materials. One excellent source is the National Institutes of Health(NIH) which includes the National Heart, Lung, and Blood Institute (NHLBI). The NHLBI has patient handouts in English and Spanish that provide patient information on a variety of topics.4 The website also provides links to several other sources for patient asthma education, including the American Lung Association, the Asthma and Allergy Foundation of America, the Asthma & Allergy Network, the Centers for Disease Control & Prevention, and the Environmental Protection Agency.4 

Two excellent sources for learning how to be effective in providing asthma education is the Association for Asthma Educators (AAE) and the American Association for Respiratory Care (AARC). They provide courses and conferences that lead to becoming an Asthma Educator Specialist (AE-C)—a credential offered through the National Board for Respiratory Care.5-7

8. Use the Teaching Method That Works Best


Effective patient education has become more accessible through technology, allowing healthcare providers to quickly customize and print educational materials tailored to individual patient needs. However, education should involve active discussion rather than simply handing out written materials.11 Use of educational tools such as videos, handouts, demonstrations, and workbooks are useful in providing instruction. 

Education should consider the patient’s (and family/caregiver) learning style, grade level for reading and comprehension, the timing and number of materials presented, health literacy, etc, in order to take the best approach for effective learning. Many educators use a teach and teach-back approach (asking patients to repeat instructions or information).1 Engaging patients by explaining the importance of their care, building rapport, and adapting information to their level of interest and understanding can improve participation, comprehension, and adherence to treatment plans.11

Conclusion

Patient education plays an important role in aerosolized medication adherence and controlling asthma symptoms.1-10 Data suggests patients equipped with greater education demonstrate high self-efficacy, which has been consistently linked to improved asthma outcomes.9 There are many excellent sources of material to support/provide effective, accurate education. Some of these include the “Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2025”1 and the American Association for Respiratory Care (AARC) publication “A Patient’s Guide to Aerosol Medication Delivery, 4th Edition.”2

RT 

Bill Pruitt, MBA, RRT, CPFT, FAARC, is a writer, lecturer, and consultant. Bill has over 40 years of experience in respiratory care in a wide variety of settings and has over 20 years teaching at the University of South Alabama in Cardiorespiratory Care. Now retired from teaching, Bill continues to provide guest lectures, participates in podcasts, and writes professionally. For more info, contact [email protected].


References

  1. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2025. Updated Nov 2025. https://www.ginasthma.org.
  2. Op’t Holt T, et al. A Patient’s Guide to Aerosol Medication Delivery, 4th Edition. Updated 2023. Available from AARC.org
  3. American Lung Association. Asthma and COPD Medicines. https://www.lung.org/getmedia/e6be8c67-a793-44a8-bd7c-96629e57c20d/respiratory-medication-chart
  4. NIH/NHLBI Asthma Resources for Patients and Caregivers. https://www.nhlbi.nih.gov/LMBBasthma/asthma-publications-patients-and-caregivers
  5. Association of Asthma Educators. https://asthmaeducators.org
  6. National Board for Respiratory Care – Asthma Education Specialist. https://www.nbrc.org/examinations/certified-asthma-educator-ae-c
  7. American Association for Respiratory Care – Asthma Education Series. https://www.aarc.org/education/asthma-education-series-2024
  8. https://pmc.ncbi.nlm.nih.gov/articles/PMC6791196
  9. https://pmc.ncbi.nlm.nih.gov/articles/PMC12505728
  10. https://www.goodrx.com/conditions/asthma/how-to-clean-inhaler
  11. https://www.wolterskluwer.com/en/expert-insights/5-strategies-for-providing-effective-patient-education