Asthma Fact Sheets How to Use Your Metered-Dose Inhaler

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Medication must be used correctly to be effective. Devices used for inhaled medications include a variety of pressurized, Metered-Dose Inhalers (MDIs), Dry Powder Inhalers (DPIs), Breath-Actuated MDIs, and Nebulizers. Each one has different steps for proper use. This educational handout deals only with Metered-Dose Inhalers.

Pressurized Metered-Dose Inhalers, currently the most commonly used, deliver a measured amount of medication and produce excellent results when used correctly. Metereddose inhalers are portable and less time consuming. Because the MDI is pressurized, a Spacer or Holding Chamber device should always be used too effectively administer the medication.

Spacers or Holding Chambers make it easier for your child to use a Metered-Dose Inhaler and breathe in the medication. Spacer devices allow a discharge of medication into a holding chamber where the medication particles are held in suspension for 3 to 5 seconds. During this time, your child can more easily breathe in the drug with one or more breathes and not worry about coordination.

Spacers increase the efficiency of inhalers. The use of spacers:

  • Makes it possible to give inhaled medicines to children and patients with poor coordination. (Spacers with oneway valves help young children use MDIs. Infants and toddlers can use spacers with mask attached instead of a mouthpiece.)
  • Reduces the local side effects (cough and oral candidiasis) from inhaled steroids and of systemic absorption because non- breathable particles are deposited in the spacer’s chamber rather than the mouth.Inhalers come in different sizes (number of actuations). There is no reliable way to determine how much medication is left in the canister. Use the table below to see how long an inhaler lasts and keep a calendar.
# Sprays 2 Sprays/Day 4 Sprays/Day 6 Sprays/Day 8 Sprays/Day
60 30 days 15 days N/A N/A
100 N/A 15 days 16 days 12 days
104 N/A 25 days 17 days 13 days
112 N/A 26 days 18 days 14 days
120 60 days 30 days 20 days 15 days
200 100 days 50 days 33 days 25 days
240 N/A 60 days 40 days 30 days

If the medication is taken as prescribed, the canister should be discarded when empty and a refill on the medication should be obtained. Please allow for ample delay time while prescription is being filled.

Special Instructions with a Brand New Spacer/Holding Chamber

Due to a static charge, the spacer/holding chamber must be primed with 8-10 puffs of a Placebo MDI or Albuterol MDI. If this is not done prior to use, the medication will be attracted to the sides and will not be delivered into the lungs. This priming only needs to be done once.

The Steps to Using a MDI with a Spacer

  1. Attach the MDI to the spacer and vigorously shake the MDI/Spacer unit.
  2. Exhale normally, then place mouthpiece in your mouth.
  3. Actuate the MDI one time only, never put more than one puff in the spacer at one time.
  4. With a good seal around the mouthpiece, inhale the mist from the spacer.
  5. Use a slow and deep inspiration
  6. Hold your breath for 5-10 seconds (count 5 elephants).
  7. Exhale slowly through your nose.
  8. Wait 30 seconds then repeat as prescribed.
  9. Rinse out mouth with water or brush your teeth. Do not swallow water.

The Steps to Using a MDI with a Spacer and a Mask

  1. Attach the MDI and mask to the spacer.
  2. Vigorously shake the MDI.
  3. Position the mask over nose and under mouth and establish a seal.
  4. Actuate MDI one time only, never put more than onepuff in the spacer at one time.
  5. Have mist inhaled from spacer with 5-8 breaths.
  6. Keep mask on face for inhalation and exhalation.
  7. If there is a proper seal, a hollow sound will be made and the valve will open and close.
  8. Wait 30 seconds.
  9. Repeat as prescribed.
  10. Rinse out mouth with water and wipe off face after administration of medication. Do not swallow water.

A Technique Without a Spacer Can be Taught, But is Not Recommended

  1. Remove the cap and hold the inhaler upright.
  2. Vigorously shake the inhaler.
  3. Tilt head back slightly and breathe out normally and fully.
  4. Open mouth and place the inhaler mouthpiece approximately two – three fingers away.
  5. Activate the inhaler and breathe in as the medication is dispensed.
  6. Hold breath for 5-10 seconds.
  7. Exhale through the nose.
  8. Wait 30 seconds.
  9. Repeat as prescribed.
  10. Rinse mouth (even more important without spacer use). Do not swallow water.
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