Metered-dose inhalers are more complicated than swallowing a pill – but, if used properly, they put the medication right where it is needed and can go to work quickly:  the airways of the lungs

Contrary to popular belief, it’s your correct inhalation, not the force of the propellant, that moves the medication past your mouth and throat into your airways. Proper technique is important. You’ve got to inhale the spray before it has a chance to land on your tongue or inside your cheek, yet slowly enough to get the medication deep into your lungs.

“It’s like driving a car,” explains Ben Francisco, PhD, PNP, AE-C, University of Missouri IMPACT Asthma Outreach and Development office. “If you leave here at 100 miles an hour, you’re going to go off the road at the first major turn – you can’t get around it. And if you take a very fast breath with your inhaler, the medication will slam into the wall of your airway at the first big curve, instead of travelling down into the lungs.”

MDI Practice Session

Check your inhalation technique. Read through the step-by-step instructions. Then try it yourself.

1. Remove the mouthpiece cap and look at the tiny exit hole where the medication comes out of the canister. It should be free of debris or white powder. If it’s not, follow package instructions to thoroughly clean the inhaler.
2. Shake the inhaler to mix the crystalline powder medication with propellants and other inactive ingredients. Check your patient instruction sheet to see if your inhaler requires shaking (and how much), as a few brands (including Atrovent® HFA and QVAR®) are blended differently and don’t need shaking.
3. Prime (actuate) the inhaler to release one dose of medication into the air. When the MDI is new or hasn’t been used in a while, the ingredients may separate. Discarding the first few doses (priming) ensures the next one you inhale contains the labeled amount of medication. Check your patient  instruction sheet for details on your inhaler.
4. Stand or sit up straight and exhale fully. This step ensures you can inhale medication slowly and deeply.
5. Place inhaler mouthpiece into your mouth (between your teeth) and close your lips tightly around it. If you use a holding chamber, insert the MDI mouthpiece into the flexible adaptor and put the chamber mouthpiece in your mouth. Hold the MDI upright, with the mouthpiece at the bottom and the top pointing up to the sky. Be sure to close your lips tightly around the mouthpiece and keep your tongue out of the way.
6. Begin to inhale slowly, then activate the inhaler a split second later (or pretend, if you want to save medication – remember, this is a practice session). If you wait too long to inhale, you won’t have enough breath left to activate it, the medicine deep into your small airways.
7. Continue inhaling slowly for 3-5 seconds, until your lungs are full. You might be surprised at how long a time that is, so test yourself. Using a stopwatch device or clock with a second hand, begin to inhale and pretend to actuate your inhaler. See how long it takes you to fill your lungs. Did you run out of room in your lungs before 3 seconds? If so, try it again, more slowly. Practice until you’re able to get it right. Then practice again…and again. Some holding chambers feature a whistle that goes off if you are inhaling too forcefully, a signal that you need to slow down.
8. Hold your breath for 10 seconds, if possible. (You can take the inhaler out of your mouth.) When you hold your breath, you allow the tiny particles of medication to settle on the surface of your airways, rather than being pushed back out.
9. Exhale slowly and repeat steps 2 through 9 for second dose. If your asthma action plan says to take a second dose, check the patient instruction sheet that came with your inhaler to see how long to wait in between. Often this is about a minute, but some devices recommend a different amount of time.
10. Replace the cap on your inhaler and store it where it won’t be exposed to moisture or extreme temperature changes. For best results, store and use the inhaler at normal room temperature – about 77 degrees F. If you need to take your inhaler out in very cold or very hot weather, keep it close to your body, not in your car or in a backpack. In cold temperatures, warm the inhaler with your hands before using it.

The Final Steps

• If you are using an inhaled corticosteroid, rinse your mouth out after you’ve taken the medication since even with a perfect inhalation, some of the medication will land on your tongue and the insides of your cheeks. Spit out the rinse; do not swallow. Neglecting to rinse can lead to fungal infections
• Clean the inhaler according to your patient instructions. If using water, leave time for the inhaler to air dry. Holding chambers also need to be rinsed according to instructions.

CountingDoses

Even the most perfectly timed inhalation won’t do you any good if there’s no medicine left in the inhaler. Keep track to know for sure, because MDIs will still feel like there’s something inside (if you shake it, for instance) or even emit a spray long after the active medication has been used up. A few devices (Advair® HFA, Flovent® HFA, Symbicort® and Ventolin® HFA) now offer built-in counters and more are in development. If yours doesn’t have one, develop a system of your own. Use a calendar for daily medications; simply mark the canister when you first open it with the current date, then figure how many days it will last, according to how many doses you take per day.

With medications like bronchodilators that you take only when you need them – when symptoms flare or you get a cold, for instance, or before exercise – you must keep track as you go. AANMA’s AsthmaTracker® daily diary system offers a perfect solution – just post it in a notebook or on a bulletin board, then fill it out each day before you go to bed, marking down when you used your inhaler and how many doses you used. Don’t forget your priming sprays – they count, too. The AsthmaTracker® can also help you keep track of when you last used your inhaler and whether it needs to be primed before using again. To order your own, call AANMA at 800.878.4403.

Related posts:

1. Maximize the Mist – Keep Inhalers Clean, Primed and Ready ^[1]
2. Holding Chambers and Spacers ^[2]
3. Nebulizer Basics ^[3]
4. Nebulizers – When Only the Mist Will Do … ^[4]