Metered-Dose Inhaler

Metered-Dose Inhaler

Know how to hold your inhaler? When to use a spacer? Learn proper technique for using and cleaning your metered-dose inhaler and when to replace it.

If you take asthma medication, then you probably use a metered-dose inhaler. It’s a simple device, but getting it right could mean the difference between getting your medication to where you need it – in the lungs – or in the air or somewhere else. Giving the little cylinder a squeeze seems easy, but here are a few tips to fine tune your technique and get the most from your asthma treatment.

What is a metered-dose inhaler?

The metered-dose inhaler is a small, pressurized can that contains aerosol medicine that you inhale. It’s often simply called an “inhaler.” Many asthma medications are taken with an inhaler. There are five parts to an inhaler:

  1. Medication
  2. Propellant (pressurized gas to push the medication out)
  3. Canister
  4. Metering valve
  5. Mouthpiece

Each time you use the inhaler, a precise measured, or “metered,” dose of medicine goes directly to your lungs. Inhalers can be used by all people with asthma age 5 and older, says the American Medical Association.

What is a spacer?

A spacer is a tube that attaches to the inhaler. It acts as a reservoir or holding chamber for the medication. This makes it easier to use your inhaler and helps ensure you get more of the medication into your lungs instead of just into your mouth or the air. A spacer is helpful for children or adults who have a hard time using an inhaler. People who use corticosteroid inhalers should use a spacer to prevent getting the medicine in their mouth, which can cause an oral yeast infection.

How to use a metered-dose inhaler

It is important to use a metered-dose inhaler the correct way to get the needed amount of medication into your lungs.

First, ask your doctor or nurse to show you how to use the inhaler. Then let them watch your technique to make sure you are doing it right. Follow all instructions for when and how to prime the inhaler.

Steps for using your inhaler:

  1. Remove the mouthpiece cover, and hold the inhaler upright. Look inside to make sure it is clear of foreign matter.
  2. Insert the inhaler into the spacer, if you have one.
  3. Shake the inhaler for five to 10 seconds.
  4. Hold your inhaler upright with the mouthpiece end at the bottom.
  5. Stand or sit upright.
  6. Tilt your head back slightly and breathe out.
  7. Use the inhaler in any one of the following ways: (A and B are the best ways, but C is OK if you are having trouble with A or B.)
  1. Open mouth wide, with inhaler one to two inches away (about the width of two fingers).
  2. Use a spacer/holding chamber and insert into your mouth.
  3. Put the inhaler directly into your mouth. Be careful not to block the inhaler with your tongue. Do not use this method with steroids.
  1. Press down on the inhaler firmly to release the medication as you start to breathe in.
  2. Breathe in slowly and completely for three to five seconds – count one-one thousand, two-one thousand, three-one thousand.
  3. Hold your breath for 10 seconds (or as long as you comfortably can up to 10 seconds) to allow the medication to go deeply into your lungs.
  4. Exhale slowly through your mouth.
  5. Repeat puffs as prescribed. Wait one minute between puffs to permit the inhaler to reload with medication, and shake before using again.
  6. Replace the cap on your inhaler/spacer.

The inhaler and spacer should be cleaned often to prevent buildup (see below).

Discard the canister after you have used the number of puffs (inhalations) indicated on the label.

Store your inhaler in a clean, sealed plastic bag.

Special instructions for inhaled corticosteroids

When taking inhaled corticosteroids, you should follow these additional instructions:

  • If you are having asthma symptoms, use your inhaled bronchodilator first and wait at least one to two minutes before using your inhaled corticosteroids. This helps open up the airways to allow the medication to be delivered deep into the lungs.
  • Always use a spacer. It improves medication delivery to the lungs and also lowers the risk of mouth infections.
  • Rinse your mouth and throat after you have finished to reduce the chance of fungal infection.
  • Store your inhaler with the valve up.

Common problems that affect medication dosage

Hand-breathing coordination can be hard to do. If you find that your medications are not as effective as you may wish, you should think about using a spacer.

To improve how well your inhaler works, make sure to:

  • Shake the inhaler several times before every puff.
  • Exhale as much air as you can push out before pressing your inhaler.
  • Breathe in through your mouth, not through your nose.

How to clean your inhaler and spacer

Clean the mouthpiece and cap at least once a week by rinsing in warm water. Make sure to shake off any excess water, and let them air-dry overnight. When dry, store in a clean, sealed plastic bag to keep out dust and debris.

When does an inhaler need to be replaced?

It is important to know how long your inhaler will last. It is not always easy to notice when you are running low on medication. Your inhaler is made to deliver the prescribed amount of medication until it is empty. You can calculate how long an inhaler will last using the following method:

  • Check the inhaler box to see how many “metered inhalations” or puffs it contains.
  • Next, figure out how many puffs you will take per day (e.g., 2 puffs, 4 times a day = 8 puffs a day).
  • Divide this number into the number of puffs contained in the canister. That will tell you how many days the inhaler canister will last. Make sure to count forward and mark the day on your calendar that the inhaler will need to be replaced. This way you can make sure you refill your prescription before you run out.
  • Example:
    • Inhaler canister contains 200 puffs.
    • You take 2 puffs, 4 times a day (2 x 4) = 8 puffs a day.
    • 200 divided by 8 = 25.
    • The inhaler canister will last 25 days.
    • In this example you would need to make sure you have a replacement canister on hand 25 days from the day you first receive the inhaler.
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