Understanding Your Medications – Part III – Metered Dose Inhalers (MDI)

  • Today we’ll talk about:
    •    Inhaler technique for Metered Dose Inhaler (MDI)
    •    How to clean and store your MDI
    •    How to tell how many doses are left in your MDI

    If you have diabetes, you wouldn’t be sent home with insulin, needles and syringes without 1.) being taught how to use them, and 2.) making sure a trained health care professional watches as you demonstrate that you’re able to use them correctly.


    But who shows you how to use a MDI? In an informal survey, doctors were asked if they provide inhaler instruction. Each of them said that the pharmacist does it.  When those very pharmacists were asked if they provide inhaler instruction every single one said that the doctor does it. This is a problem and that’s why we’re talking about inhaler technique.

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    Here’s a short scene about MDI use from an episode of the television show “House.”

     

    I’m sure you know that the lady in this video was not using her inhaler correctly! But seriously, even smart people who are ‘good’ patients should have MDI instruction. Demonstrate your inhaler technique to a licensed Respiratory Therapist or a nurse who specializes in COPD and ask if you are using good technique. Ask also how you can avoid unwanted side effects.

    There are two main types of delivery for inhaled medication: Metered dose inhalers (MDIs) and dry powder inhalers (DPIs). We’ll discuss DPIs in Part IV of this series. A metered dose inhaler consists of a pressurized canister, an L-shaped plastic sleeve with a mouthpiece and cap on one end. Medication in a MDI comes out as a spray mist. When using a MDI it is best to use a spacer or holding chamber.

    Use of MDI with Spacer or Holding Chamber
    Using a MDI with a spacer or holding chamber helps you get the maximum amount of inhaled medicine into your lungs. The spray from a MDI comes out very fast and nobody can breathe the medicine in as fast as it comes out. Also, it’s difficult to position the inhaler so the medicine goes deep into your lungs. A spacer or holding chamber helps hold the mist for a short time so you can breathe it in more slowly, and position it well to get the medicine deeper into your lungs.


    It’s common for people to feel they’re “not getting anything” when using a spacer or holding chamber. But, think about this: If you’re feeling the spray on your throat and your tongue, it is not getting down into your lungs where it belongs. You don’t have to feel the spray in order for it to work.


    A spacer simply creates space between the MDI spray and your mouth. A spacer can be a simple tube 1-5 inches long, and can be made from something as ordinary as a clean cardboard tube from a roll of paper towels. See the end of this sharepost for a video demonstration.


    A holding chamber is more than just a tube. It has one or more valves, helping control the flow of medicine according to your breathing effort. A holding chamber requires a doctor’s prescription. See the end of this sharepost for a video demonstration.


  • Sometimes health care professionals assume patients don’t want to be bothered with a spacer or holding chamber so that’s why it’s often not included with the MDI prescription. If your doctor knows that you are willing to use one, he or she may be more likely to order it. Ask your doctor about a spacer or holding chamber so you can have the best chance of getting as much medicine into your lungs as possible.

    Use of MDI with a spacer or holding chamber

    • Remove the caps from both your MDI sleeve / mouthpiece and your holding chamber.
    • Insert the open MDI mouthpiece into the soft end of the spacer or holding chamber.
    • Hold the MDI sleeve and spacer or holding chamber, with your thumb on the base and your middle finger on the top of the canister.
    • Shake for about 10 seconds.
    • With your shoulders relaxed, gently breathe out through pursed lips.
    • Put the spacer or holding chamber mouthpiece in your mouth.
    • Press the MDI canister down.
    • Breathe in slowly and deeply for 5 seconds.
    • Hold your breath for up to 10 seconds if possible.
    • Repeat steps 3-9 when more than one puff is prescribed.
    • Rinse and spit after using a corticosteroid MDI (see Part II)


    Use of MDI - open mouth method
    The open mouth technique is less effective than the spacer / holding chamber method.

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    • Remove the cap.
    • Hold the MDI with your thumb on the base of the mouthpiece and your middle finger on the top of the canister.
    • Shake the MDI for about 10 seconds.
    • Hold the mouthpiece 2-3 finger widths in front of your mouth.
    • With shoulders relaxed, gently breathe out through pursed lips.
    • Tilt your head back slightly and open your mouth wide.
    • Press the canister down and at the same time begin a slow, deep breath.
    • Continue to breathe in slowly and deeply over 5 seconds.
    • Hold your breath for up to 10 seconds if you can.
    • Repeat steps 3-9 when more than one puff is prescribed.
    • Rinse and spit after using a corticosteroid MDI (see Part II)


    Use of MDI - closed mouth method
    The open mouth method is considered the least effective method of MDI use.

    • Remove the cap.
    • Hold the inhaler with your thumb on the base of the mouthpiece and your middle finger on the top of the canister.
    • Shake the inhaler for about 10 seconds.
    • With shoulders relaxed, gently breathe out through pursed lips.
    • Tilt your head back slightly
    • Put the mouthpiece yous not blocking the opening).
    • Press the MDI canister down and at the same time begin a slow, deep breath.
    • Continue to breathe in slowly and deeply over 5 seconds.
    • Hold your breath for up to 10 seconds if you can.
    • Repeat steps 4-9 when more than one puff is prescribed.
    • Rinse and spit after using a corticosteroid inhaler (see Part II)


    Cleaning and storage
    Clean your MDI sleeve once a week.

    • Remove the metal canister from the plastic sleeve.
    • Separate the sleeve and cap.
    • Rinse the sleeve and cap in warm water. Let them air dry overnight.
    • In the morning, put the canister inside the sleeve. Put the cap on.
    • Do not get the canister wet.

     

     

    Before each use, inspect your inhaler to make sure it’s free from foreign objects, hair or lint. Look at the tiny hole where the medicine spray comes out of your MDI. It should look clean, with no powder in or around the hole.

  • Keep your MDI at room temperature. Do not leave it in your car. Extreme heat or cold could cause it to not function.

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    How do I tell how many doses are left in my MDI?
    If your MDI has a built-in dose counter, that will tell you how many puffs remain.
    If your MDI doesn’t have a dose counter, here is an easy way to know how many doses remain.

    • Look on the box to see how many puffs are in your new MDI.
    • If you use it regularly, divide the number of puffs you take each day into the number on the box. For example, if a new MDI contains 200 puffs and you use 8 puffs (2 puffs, 4 times) a day, that inhaler should last 25 days.
    • Don’t wait 25 days to get a new one! Mark on your calendar the day you start a new MDI, then count 20 days from there and make note to pick up your new MDI on that day. This way if something comes up and you’re unable to get to the pharmacy right away, you still have some time to get there before your new MDI runs out.  
    • If you use your inhaler only once in a while, stick a blank label on the MDI sleeve and make a mark for each puff you take. If your inhaler contains 200 puffs, call for a refill after you’ve used 180 puffs.

    Do not float your MDI canister in water to see how empty or full it is.

    Watch for Part IV, the last part of our Medication series, when we’ll talk about dry powder inhalers (DPIs), nebulizers, and timing and sequencing of inhaled medications.

    For more about using your MDI:

    MDI with Spacer

    MDI with Holding Chamber


    MDI Closed mouth technique


Published On: February 27, 2012