Metered-Dose Inhaler, How to Use

The metered-dose inhaler (MDI) is a container of medicine that releases a mist of medicine. Your child inhales the mist through his mouth into the airways of his lungs.

Inhaled asthma medicines contain a gas that helps the medicine get into your lungs. Chlorofluorocarbon (CFC) is the gas that used to be used in inhalers. Because it depletes the ozone layer in our atmosphere, hydrofluoroalkane (HFA) is now used instead. Although the gas in inhalers has changed, the medicine in HFA inhalers is the same as the medicine in CFC inhalers. The HFA inhaler looks just like a CFC inhaler but is a little different. The spray comes out with less force, is warmer, and has a slightly different taste. It is not felt as much in the throat when inhaled, but your child still gets the right amount of medicine.

The inhaler can be used alone, but it is highly recommended that your child use a spacer or valved holding device attached to the inhaler.

Several different types of medicines are available as metered-dose inhalers, including:

• bronchodilators (ProAir HFA, Proventil HFA, Ventolin HFA, or Maxair)
• inhaled steroids (Flovent HFA, Pulmicort, Qvar)
• combinations of a long-acting bronchodilator and an inhaled steroid (ADVAIR HFA, Symbicort)
• ipratropium bromide (Atrovent HFA).

When a child is using more than one type of inhaler, he will usually use the bronchodilator first.

There are several ways to use an inhaler. If no spacer is available, the technique most often recommended is as follows:

1. Shake the inhaler vigorously.
2. If the inhaler has not been used before or if the inhaler has not been used for a while, you must then “prime” the inhaler. Do this by spraying 2 or 3 sprays of the medicine into the air. Each time you use the inhaler, the next dose is drawn into a chamber inside the inhaler. If the inhaler has not been used or sits for a long time without being used, some of the medicine leaks out of the holding area. This means you will not get the full dose of medicine the next time it is used. Priming the inhaler makes sure that you get the full dose of the medicine.
3. Hold the inhaler upright so the mouthpiece is at the bottom.
4. For many inhalers the best way to get the medicine into the lungs is to hold the mouthpiece 1 to 2 inches (about 2 to 3 finger widths) in front of an open mouth. This method helps keep medicine from ending up in your child’s mouth, which may cause increased side effects. It also helps medicine to reach your child’s lungs rather than the back of his throat. If the open mouth technique is too difficult, you may also place the inhaler mouthpiece directly into your child’s mouth and have your child close his lips snugly around it. Talk with your provider or pharmacist about this.
5. Have your child breathe out normally.
6. Press the inhaler down once so it releases a spray of medicine into the mouth while your child breathes in slowly. (One spray is often called a puff.)
7. Have your child continue breathing in as slowly and deeply as possible.
8. Have your child hold his breath for 10 seconds or as long as is comfortable. This gives the medicine time to reach the airways.
9. Have your child breathe out slowly.

After your child takes a few normal breaths, repeat these steps for another inhalation (puff) if required. Take the number of puffs prescribed by your healthcare provider.

If your child is taking a inhaled steroid medicine, have him rinse his mouth with water after the last dose and spit the water out.

Wash the plastic case for the inhaler once a week with soapy tap water. Rinse well and let the parts air dry.

Do not store your child’s inhaler in places that may get very hot or cold (like a car).