While this seems to work for you (and obviously it's up to you do things how you want to), for the benefit of others reading, the correct technique is to do each puff of inhaler separately, so 1 puff into spacer, breathe it in, then repeat with the second puff.
This is Asthma UK's page on techniques for each type of inhaler:
I shall try 2 separate steps as you have suggested and see if my peak flow improves in a week's time.
I feel that my 'extreme' technique certainly helps me and will continue with it.
The patient leaflet instructions seem too 'gentle' for a competitive cyclist, such as myself.
After all, I am used to 'maxing' it out on the bike, climbing hills, with my BPM at 175 (in the uncomfortable zone) for 10 minutes at a time - down from 200 as a teenager.
All the best!
Alps
LysistrataAdministratorCommunity Ambassador in reply to
It's good that it still seems to work ok for you, but just wanted to add for anyone reading that being able to tolerate a lot of discomfort with your breathing and/or heart rate isn't necessary or for most people the best approach to taking your inhaler, even if it's useful for cycling or any other sport. Taking your inhaler, and having asthma, is nothing like a competitive sport - even if you're a competitive athlete.
Yes I agree, it's important for asthmatics in general to take their inhalers in the recommended way to maximise the drug efficacy. If they're not taken properly they may as well not be taken.
The one dose at a time is a standard advice thing as 2 puffs are less effective when done together. Tidal breathing or 1 suck and hold per puff are the correct techniques with the spacer.
Taking meds isn’t a sport, there’s no thing as ‘too gentle’ with the MDI inhaler technique through spacer if you are doing it correctly. I bet you don’t down your tablets with a pint of water, cause it’s not needed, nor would you want to be stabbed as hard as possible with any injections cause it wouldn’t make any difference other than maybe give you a bruise.
I’m glad this technique seems to work ok for you, but as an ex-international gymnast/trampolinist, and national martial artist, the gentle works and works well for me.
The competitive nature can come out in your PF technique tho! That’s the best place for it!!! Compete against yourself/machine, it’s a lot of ‘fun’ 😉😂 (don’t compete against others tho - there’s way too many factors that affect best PF!)
So for anyone else reading as the others have said, stick to the advised technique as they’ve been found to be the best. Asthma is not a competitive sport, so long as you feel the technique you use works you’re doing it just fine!
Thanks for your take on all this and great that you were an international gymnast and trampolinist and national martial artist.
Are you still into sports?
My reasoning, way back when I was given the Seretide and spacer at age 40 I feel was along these lines -
- Seretide can only 'address' the mild inflammation in the lung alveoli if it can reach them
- Therefore, if my technique is 'gentle' this may mean that the Seretide is not getting to 100% of the alveoli in the lungs? maybe only 50%?
- So, ensuring my lungs are well and truly 'empty' (by the technique I have described) before inhaling the Seretide, ensures that the Seretide will get to as near to 100% of the alveoli as possible?
Additionally, I take 3 shots of Ventolin, again using the above technique, before a Sunday bike ride. Again, I feel that this is a way to add a bit more lung capacity?
And for many years now, that's the only time I take any Ventolin.
Lung capacity won’t change with drug. That’s the maximum your lungs can inflate. Some people have larger lungs, others smaller. This is what changes PF best (sportiness is one factor than can increase lung size over time... for example my predicted is 440 my best is 620). What using ventolin pre exercise does is prevent the airways narrowing. In asthma, airway narrowing/inflammation/mucus production occurs when the lungs are irritated and this is what drops our PF.
So long as your airways are open, normal breathing strength will get the aerosol into all your alveoli, so long as you take a deeper breath. A gentle inflation will work exactly the same as a sharp one, however for many asthmatics (esp those in flares at the time) the ‘sharp and hard’ in breath can be enough to trigger off the inflammation (just ask anyone whose had to do a lung function test... this often can make people cough if they’ve fully emptied prior.
The only time the alveoli are ‘shut off’ shall we say is if the inflammation (for lack of a better word) is so great that the airways have narrowed to the point of little going through them. And this causes desaturation and requires emergency a&e treatment.
The technique advised on the instruction leaflets and in the AUK videos will get to 100% if the alveoli unless you’re in a flare in which they’ll get the salb to where it can start working and that will open you up more by dilating your airways. If you are already ‘open’ then so long as you fully inflate your lungs, so a good technique is; breathe normally and shake inhaler, stop shaking and fully empty lungs, spray 1 puff into spacer and start a gentle deep breathe in (assuming you want to do the breathe and hold technique), hold for up to 10sec, then return to breathing normally. Then you repeat from the shaking for two 2nd dose. Afterward do your rinsing 😉.
I think breathing in too hard (ie making your spacer hum) can result in poor technique as the drug hits the back of your throat and gets stuck before travelling down into your lungs.
Sports wise I now coach gym, choreograph the routines and do dance myself, lungs permitting (I have severe asthma).
I hope this helps. I think twinkly29 has already linked to the auk pages, and one of their asthma nurses may pop and say hi (you never know 😉) but I think that’s everything 😅
Thanks Emma for a very insightful and informative reply
I've taken it all on board for sure
And very sorry to hear about your severe atopic and eosinophilic asthma - what bad luck
(What helps with this?)
And especially so, as you were into gymnastics and trampolining at the top level
Good to hear you're coaching though and passing on what you have learnt as a top sportsperson - keep it up!
Hi Alpsholiday, it looks like you've already been given some great tips and advice here, but if you want to speak to one of us nurses on the helpline about improving your inhaler technique and asthma management please don't hesitate to give us a ring 0300 2225800 M-F 0915-5 option 3 for nurses.☎️👍😊asthma.org.uk/advice/manage...
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
Having issues with relvar ellipta
What would you do next?
Asthma and feeling low and poorly
Peak Flow doesn't always drop despite being symptomatic. 
Tips/alternatives for a refusing 4 year old?!?!
