How to use your Metered Dose Inhaler

Use of  Metered Dose Inhaler

What is a metered dose inhaler?

A metered dose inhaler (MDI), also known as an aerosol inhaler or puffer, is a device for delivering medicine directly into the lungs. It consists of a pressurised metal canister containing a solution or suspension of medicine, placed within a plastic case with a mouthpiece. When the canister is pushed down, a valve delivers a measured dose of medicine in a fine mist. This is inhaled into the lungs via the mouthpiece. Using an inhaler delivers your medicine directly into the lungs where it is needed.

Using such an inhaler device can require considerable coordination, but it is important that the correct technique is used. If not, you won’t fully inhale the correct dose of your medicine. This not only makes it less effective, but may also result in the medicine ending up in your mouth or throat, where it can cause side effects such as throat irritation.

How to use an MDI

1. Sit up straight or stand up and lift the chin to open the airways.
2. Remove the cap from the mouthpiece and shake the inhaler vigorously.
3. If you haven’t used the inhaler for a week or more, or it is the first time you have used the inhaler, spray it into the air first to check that it works.
4. Take a few deep breaths and then breathe out gently. Immediately place the mouthpiece in your mouth and put your teeth around it (not in front of it and do not bite it), and seal your lips around the mouthpiece, holding it between your lips.
5. Start to breathe in slowly and deeply through the mouthpiece. As you breathe in, simultaneously press down on the inhaler canister to release the medicine. One press releases one puff of medicine.
6. Continue to breathe in deeply to ensure the medicine gets into your lungs.
7. Hold your breath for 10 seconds or as long as you comfortably can, before breathing out slowly.
8. If you need to take another puff, wait for 30 seconds, shake your inhaler again then repeat steps 4 to 7.
9. Replace the cap on the mouthpiece.

Other useful advice

* MDIs are much more effective and easy to use when used with a spacer device.
* Practice using your inhaler in front of the mirror a few times. If you see mist coming from the top of the inhaler, or from the sides of your mouth, or your nostrils, you are not inhaling the dose correctly.
* You can check your inhaler technique with your doctor, practice nurse or pharmacist.
* If you can’t get to grips with the coordination of an MDI, there are several other types of inhaler on the market (eg Autohalers, Accuhalers, Diskhalers). You may find some of these easier to use, so talk to your doctor, practice nurse or pharmacist for advice about which one may be best for you.
* If you have weak hands you may find it easier to hold the inhaler with both hands and push the canister down with both index fingers rather than one. There is also a device available called a Haleraid, to help people use aerosol inhalers. Ask your pharmacist or practice nurse about this.
* The propellants used in aerosol inhalers have been gradually replaced by more environmentally friendly CFC-free propellants. The new inhalers may look, feel and taste different but they will supply exactly the same medicine and are just as effective.
* It is important to clean your inhaler regularly about once a week, otherwise it may not work properly. Remove the metal canister and mouthpiece cap from the case of the inhaler. Wash the case and cap in warm soapy water. Rinse in warm water then leave to dry. The holes in the valve sticking out of the bottom of the canister can sometimes become blocked – they can be cleaned with a pin.
* Avoid spraying the inhaler into your eyes, as this can be harmful.
* Always use your medicines as advised by your doctor or pharmacist.
* Don’t give your medicines to anyone else to use, even if they have the same symptoms as you. They may be harmful to other people.
* Always keep medicines out of the reach of children.
* If you forget to take a dose of your inhaler, take the dose as soon as you remember, and then go on as before.
* STORAGE: all inhaler devices should be stored in a cool, dry place and out of direct sunlight.
* Inform your doctor or pharmacist if you accidentally take more than you were supposed to.

Preventers and relievers

    * Inhalers are usually colour coded. Blue inhalers are ‘relievers’. They contain medicine to relax the airways such as salbutamol (eg Ventolin) or terbutaline (eg Bricanyl), and are used to relieve shortness of breath and wheezing. They should work within a few minutes.
* If you find your reliever becomes less effective or you need to use it more frequently, talk to your doctor or practice nurse as soon as possible. Your treatment may need to be altered.
* Brown/beige/white/red/orange inhalers are ‘preventers’ (although some generic salbutamol inhalers are also white). Preventers contain medicine that reduces inflammation in the airways and prevents asthma attacks. They must be used regularly as directed by your doctor in order to prevent shortness of breath and wheezing.
* If you have a preventer inhaler that contains a corticosteroid (eg beclometasone, fluticasone) you should rinse your mouth with water after using it. This helps prevent the oral thrush that can be a side effect of this type of inhaler.
* If you are using both preventer and reliever inhalers, it is important that you use the reliever first. This helps open the airway passages and allows the preventer medicine to get down into the lungs more effectively.