Q: What is the open-mouth technique vs. the closed-mouth technique when using a metered-dose inhaler? And which is best for children?

Mark Corbett, MD: The open-mouth technique is when you hold the metered-dose inhaler (MDI) about 1-2 inches away from your open mouth before you activate the inhaler. The closed-mouth technique is when you put the mouthpiece between your teeth and close your lips tightly around it before activating the inhaler.

The open-mouth technique is the preferred technique.

However, children may find both techniques to be difficult. Since there’s so much risk for error, I recommend children use a valved holding chamber or spacer with the MDI.

Valved holding chambers and spacers are designed to capture the medicine as it sprays out. The medicine is trapped long enough inside the chamber so you can inhale at your own speed.

If you have a well-coordinated child who can demonstrate good technique using the open-mouth technique, that’s fine. But it may not be practical for most children.

Q: When using a metered-dose inhaler, is it more effective to hold in the asthma medication as long as possible?

Dr. Corbett: Ten seconds is what’s recommended. That should be long enough. Holding it much longer is not going to provide any extra benefit. Don’t make taking your asthma medicine too difficult for yourself. Keep it simple.

Mark Corbett, MD, FACAAI, is a board-certified allergist and immunologist with Family Allergy & Asthma in Louisville, Kentucky. He is the 2021 President-Elect of the American College of Allergy, Asthma & Immunology (ACAAI) and serves on the College’s Board of Regents.

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