METERED DOSE INHALER (MDI)

Here's what to do:

1.Remove the cap and hold the inhaler
upright.

2.Shake the inhaler.

3.Tilt your head back slightly and breathe

out.

4.Hold the inhaler as in one of the

pictures to the right. A or B are the
most effective, but C is okay for
people who are unable to use A or
B.

5.Spacers are useful for all patients,

especially young children and older
adults (see picture B).

6.Press down on the inhaler to release

the medicine as you start to breathe
in slowly.

7.Breathe in slowly for 3 to 5 seconds.

8.Hold your breath for 10 seconds to

allow medicine to go deeply into
your lungs.

Repeat puffs as directed. Wait 1 minute

between puffs to allow the second puff to
get into the lungs better.
Do’s and Don’ts the best way to deliver the
medication.
Most Recent
DON'T * While he holds the inhaler
in the proper position, have
* Don't let the patient inhale
him place his thumb under
too quickly.
the mouthpiece and one or
* Don't let him hold the two fingers on top of the
inhaler upside down or canister.
sideways.
* Before he uses the inhaler,
* Don't have him deliver have him take a deep breath
more than one puff with each and exhale slowly.
inspiration.
* Tell him to continue
breathing in as the
medication is released and to
continue inhaling slowly and
DO deeply for 3 to 5 seconds.

* Have your patient sit up * Tell him to hold his breath

straight. for 8 to 10 seconds while the
medication reaches deep into
* Assess his ability to hold
his airways, then exhale
and manipulate the inhaler
through pursed lips.
and depress the canister.
* Teach him to repeat
* Explain the steps for proper
inhalations as directed,
use.
allowing 1 minute between
* Have the patient shake the puffs.
inhaler well and hold it with
* Have him replace the cap
the canister upright 1 to 2
on the mouthpiece when he's
inches (2.5 to 5 cm) from his
finished.
open mouth. Tell him this is
 5. Assess client’s ability to learn: client
* If he uses an inhaler that
should no be fatigued, in pain, or in
contains a corticosteroid, tell respiratory distress; assess level of
understanding of technical
him to rinse his mouth with vocabulary terms.
water afterward. 6. Assess client’s knowledge and
understanding of disease and
* Show him how to remove purpose and action of prescribed
the medication canister and medications.
clean the inhaler in warm 7. Assess medication schedule and number
of inhalations prescribed for each
water. Medication that's dose.
accumulated around the 8. If previously instructed in self-
mouthpiece can interfere with administration of inhaled medicine,
proper distribution during assess client’s technique in using
later use. an inhaler.
9. Instruct client in comfortable
environment by sitting in chair in
hospital room or sitting at kitchen
table in home.
10. Provide adequate time for teaching
session.
11. Wash hands and arrange equipment
needed.
12. Allow client opportunity to
manipulate inhaler, canister, and
space device. Explain and
demonstrate how canister fits into
inhaler.
13. Explain what metered dose is, and
warn client about overuse of
Using Metered-Dose Inhaler inhaler, including medication side
effects.
1. Review prescriber’s order, including 14. Explain steps for administering
client’s name, medication name, inhaled dose of medication
number of inhalations. (demonstrate steps when possible):
2. Identify client, compare name on MAR Remove mouthpiece cover from
with client’s ID bracelet, and ask inhaler
client’s name. Shake inhaler well.
3. Assess client’s ability to hold, Have client take a deep breath
manipulate, and depress canister and exhale.
and inhaler. Instruct the client to position the
4. Assess client’s readiness to learn: client inhaler in one of two ways.
asks questions about medication, Open lips and place
disease, or complications; requests inhaler in mouth
education in use of inhaler; is with opening
mentally alert; participates in own toward pack of
care. throat.
 Position the device 1 to dose.
2 in from the 18. Explain that client may feel
mouth. gagging sensation in throat caused
With the inhaler properly by droplets of medication on
positioned, have client pharynx or tongue.
hold inhaler with thumb at 19. Instruct client in removing
the mouthpiece and the medication canister and cleaning
index finger and middle inhaler in warm water.
finger at the top. This is 20. Ask if client has any questions.
called a three-point or 21. Have client explain and
lateral hand position. demonstrate steps in use of inhaler.
Instruct client to tilt head back 22. Ask client to explain medication
slightly, inhale slowly and schedule.
deeply through mouth, and 23. Ask client to describe side effects
depress medication of medication and criteria for
canister fully. calling prescriber.
Hold breath for approximately 24. After medication instillation, assess
10 seconds. client’s respirations and auscultate
15. Explain steps to administer inhaled lungs.
dose of medication using a spacer
such as an Aerochamber
(demonstrate when possible):
Remove mouthpiece cover from
MDI and mouthpiece of
Aerochamber.
Insert MDI into end of
Aerochamber.
Shake inhaler well.
Place Aerochamber mouthpiece
in mouth and close lips.
Do not insert beyond
raised lip on mouthpiece.
Avoid covering small exhalation
slots with the lips.
Breathe normally through
Aerochamber mouthpiece.
Depress medication canister,
spraying one puff into
Aerochamber.
Breathe in slowly and fully (for
5 seconds).
Hold full breath for 5 to 10
seconds.
16. Instruct client to wait 2 to 5
minutes between inhalations or as
ordered by prescriber.
17. Instruct client against repeating
inhalations before next scheduled