Using Inhaled Medications

It requires practice to correctly use the devices needed to inhale your COPD medications. With the proper instructions, you can learn to use these devices effectively to get the full benefit from your medications.

Inhaled medications are often taken by using a device called a metered dose inhaler, or "MDI." When inhaled correctly, the medication has a better chance of reaching the small airways. This increases the medication's effectiveness.

MDI features

• Pressurized canister of medicine in a plastic holder with a mouthpiece
• Delivers reliable, consistent dose of medicine
• The open mouth technique or the use of a spacer is recommended
• Spacer reduces side effects of inhaled steroids

MDI technique: Open mouth technique

• Remove the cap from the MDI and shake it well.
• Hold the MDI by placing your index finger on top of the metal canister and thumb on the bottom of the plastic mouthpiece.
• Tilt your head back slightly, open your mouth wide, and place the MDI about 2 inches in front of your mouth.
• As you begin to breathe in slowly through your mouth, press down on the metal canister one time. Continue to breathe in slowly and as deeply as you can.
• Hold your breath for at least 10 seconds to allow the medication to deposit in the airways.
• Wait at least one minute and repeat the above steps. Follow the dosage prescribed by your doctor.
• Replace the cap on your MDI when you are finished.
• If you are using a corticosteroid MDI, gargle and rinse your mouth with water or mouthwash after each use.

Technique for MDI with spacer

A spacer is a chamber that attaches to the MDI and holds the burst of medication. This makes taking the MDI easier and helps get the medication into the lungs better. A MDI may sometimes be used without a spacer. Your health care provider will decide if this is appropriate for you.

• Remove the cap from the MDI and spacer device. Shake well.
• Insert the MDI into the open end of the spacer (opposite the mouthpiece).
• Place the mouthpiece of the spacer between your teeth and seal your lips tightly around it.
• Breathe out completely.
• Press the canister once.
• Breathe in slowly and completely through your mouth. If you hear a horn-like sound, you are breathing too quickly and need to slow down.
• Hold your breath for at least 10 seconds to allow the medication to deposit in the lungs.
• Wait at least one minute and repeat the above steps. Some MDIs require more than 2 puffs. Follow the dosage ordered by your doctor.
• Replace the cap on your MDI when done.
• If you are using a corticosteroid MDI, gargle and rinse your mouth with water or mouthwash after each use.

Caring for your MDI and spacer

Rinse the plastic holder of the MDI with warm water every 1 to 2 days to prevent the holes from getting clogged.

Clean the spacer every other day. (If you are using the spacer intermittently, you may only need to clean it once a week.) Remove the soft ring at the end of the spacer, soak the spacer and ring in warm water with mild detergent, and carefully clean. Rinse well in warm water. Air dry completely or dry carefully with a paper towel before putting back together.

Important notes

Patients receiving bronchodilators (albuterol, salmeterol) by inhalation should use the metered dose inhaler (MDI) several minutes before using the steroid inhaler.

Prime your inhaler by releasing one puff of medicine into the room before you use a new canister for the first time.

Features of MDI with inspirease spacer:

• Designed for taking only one puff of medication at a time
• Makes MDI technique much simpler because you first release the medication into the chamber (reservoir bag), where it is held until you inhale.

1. Press down firmly on the canister to release one puff of medication into the reservoir bag.

2. Breathe in slowly through your mouth. Continue to breathe in until the bag is completely closed. If you hear a whistling sound, breathe more slowly until the whistling stops.

3. Hold your breath and count to five slowly, allowing the medication to settle in the airways of the lungs. Then breathe out into the bag slowly.

Closed mouth technique

With the closed-mouth technique, you place the MDI mouthpiece directly into your mouth and close your lips snugly around it. The rest of the technique is the same as the open mouth technique.

When this technique is used: The closed mouth technique MUST be used with dry powder inhalers or breath-actuated inhalers. The closed mouth technique MAY be used if the open mouth technique can not be mastered.

Some potential problems with this technique include:

• Large medicine particles end up in your mouth and are absorbed into the bloodstream, causing increased side effects
• Smaller particles move so fast that they strike the back of the throat, causing less medicine to reach the airways
• It is not possible for an observer to determine if you have good hand-breath coordination

Metered dose inhaler refill schedule

Your doctor has prescribed a metered dose inhaler (MDI) for you to use. You need to know how long your MDI canister will last.

The number of puffs contained in your inhaler is printed on the side of the canister. (Note: The number of puffs in inhalers varies.) After you have used that number of puffs, you must discard your inhaler, even if it continues to spray, because you will not be getting the amount of medicine you need.

To be sure you have enough medicine when you need it, keep track of how many puffs you use. To check how long your MDI will last, use this simple equation:

How many puffs x how often per day = total number of puffs per day

Using the chart below, find your MDI name and follow over to the total number of puffs per day. This will give you a total number of days available in the MDI.

For example, Ventolin
2 puffs x 4 times per day = 8 puffs total per day

At 200 puffs, the MDI will last 25 days.

*Make sure that you contact your pharmacy five to seven days before your canister runs out.

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 8/15/2008...#8694