How to Use a Metered Dose Inhaler

A metered dose inhaler is a handheld device for taking medicine that must be breathed into the lungs (inhaled). The device can be used to deliver a variety of inhaled medicines, including:

• Quick relief or rescue medicines, such as bronchodilators.
• Controller medicines, such as corticosteroids.

The medicine is delivered by pushing down on a metal canister to release a preset amount of spray and medicine. Each device contains the amount of medicine that is needed for a preset number of uses (inhalations).

Your health care provider may recommend that you use a spacer with your inhaler to help you take the medicine more effectively. A spacer is a plastic tube with a mouthpiece on one end and an opening that connects to the inhaler on the other end. A spacer holds the medicine in a tube for a short time, which allows you to inhale more medicine.

What are the risks?

If you do not use your inhaler correctly, medicine might not reach your lungs to help you breathe.

Inhaler medicine can cause side effects, such as:

• Mouth or throat infection.
• Cough.
• Hoarseness.
• Headache.
• Nausea and vomiting.
• Lung infection (pneumonia) in people who have a lung condition called COPD.

How to use a metered dose inhaler without a spacer

1. Remove the cap from the inhaler.
2. If you are using the inhaler for the first time, shake it for 5 seconds, turn it away from your face, then release 4 puffs into the air. This is called priming.
3. Shake the inhaler for 5 seconds.
4. Position the inhaler so the top of the canister faces up.
5. Put your index finger on the top of the medicine canister. Support the bottom of the inhaler with your thumb.
6. Breathe out normally and as completely as possible, away from the inhaler.
7. Either place the inhaler between your teeth and close your lips tightly around the mouthpiece, or hold the inhaler 1–2 inches (2.5–5 cm) away from your open mouth. Keep your tongue down out of the way. If you are unsure which technique to use, ask your health care provider.
8. Press the canister down with your index finger to release the medicine, then inhale deeply and slowly through your mouth (not your nose) until your lungs are completely filled. Inhaling should take 4–6 seconds.
9. Hold the medicine in your lungs for 5–10 seconds (10 seconds is best). This helps the medicine get into the small airways of your lungs.
10. With your lips in a tight circle (pursed), breathe out slowly.
11. Repeat steps 3–10 until you have taken the number of puffs that your health care provider directed. Wait about 1 minute between puffs or as directed.
12. Put the cap on the inhaler.
13. If you are using a steroid inhaler, rinse your mouth with water, gargle, and spit out the water. Do not swallow the water.

How to use a metered dose inhaler with a spacer

1. Remove the cap from the inhaler.
2. If you are using the inhaler for the first time, shake it for 5 seconds, turn it away from your face, then release 4 puffs into the air. This is called priming.
3. Shake the inhaler for 5 seconds.
4. Place the open end of the spacer onto the inhaler mouthpiece.
5. Position the inhaler so the top of the canister faces up and the spacer mouthpiece faces you.
6. Put your index finger on the top of the medicine canister. Support the bottom of the inhaler and the spacer with your thumb.
7. Breathe out normally and as completely as possible, away from the spacer.
8. Place the spacer between your teeth and close your lips tightly around it. Keep your tongue down out of the way.
9. Press the canister down with your index finger to release the medicine, then inhale deeply and slowly through your mouth (not your nose) until your lungs are completely filled. Inhaling should take 4–6 seconds.
10. Hold the medicine in your lungs for 5–10 seconds (10 seconds is best). This helps the medicine get into the small airways of your lungs.
11. With your lips in a tight circle (pursed), breathe out slowly.
12. Repeat steps 3–11 until you have taken the number of puffs that your health care provider directed. Wait about 1 minute between puffs or as directed.
13. Remove the spacer from the inhaler and put the cap on the inhaler.
14. If you are using a steroid inhaler, rinse your mouth with water, gargle, and spit out the water. Do not swallow the water.

Follow these instructions at home:

• Take your inhaled medicine only as told by your health care provider. Do not use the inhaler more than directed by your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.
• If your inhaler has a counter, you can check it to determine how full your inhaler is. If your inhaler does not have a counter, ask your health care provider when you will need to refill your inhaler and write the refill date on a calendar or on your inhaler canister. Note that you cannot know when an inhaler is empty by shaking it.
• Follow directions on the package insert for care and cleaning of your inhaler and spacer.

Contact a health care provider if:

• Symptoms are only partially relieved with your inhaler.
• You are having trouble using your inhaler.
• You have an increase in phlegm.
• You have headaches.

Get help right away if:

• You feel little or no relief after using your inhaler.
• You have dizziness.
• You have a fast heart rate.
• You have chills or a fever.
• You have night sweats.
• There is blood in your phlegm.

Summary

• A metered dose inhaler is a handheld device for taking medicine that must be breathed into the lungs (inhaled).
• The medicine is delivered by pushing down on a metal canister to release a preset amount of spray and medicine.
• Each device contains the amount of medicine that is needed for a preset number of uses (inhalations).