Did you know that using your inhaler incorrectly could result in a decreased amount of the medicine reaching your lungs? Worse yet, some mistakes in technique will result in no medicine reaching your lungs.

The American Association for Respiratory Care wants you to understand how to use your inhaler correctly so that you get the correct dose of medicine, making it easier to control your symptoms of asthma, COPD, or other respiratory diseases. Read on to see if you are using your inhaled medications correctly and learn useful tips about your inhaled medicine.

How to Use Your MDI

MDI with a Spacer/Holding Chamber

• Wash your hands.
• If you have not already done so, place medicine canister into the mouthpiece device. Make sure that canister is tightly secured into the hole of the mouthpiece device.
• Remove plastic cap from MDI mouthpiece.
• Shake the MDI canister to mix the medicine and propellant.
• Remove the spacer cap and connect to the MDI mouthpiece.
• Place the mouthpiece of your spacer into your mouth.
• Close your lips around the mouthpiece and press down on the canister to release the medicine/puff.
•  Inhale slowly and completely.
• Take spacer device out of your mouth.
•  Hold your breath for up to 10 seconds to allow the medicine to reach deep into your lungs.
• Slowly breathe out.
• Repeat steps 1-11 if your doctor has ordered more than one puff
• Put cap back onto the inhaler and spacer.

MDI Without a Spacer*

• Wash your hands.
• If you have not already done so, place medicine canister into the mouthpiece device. Make sure that canister is tightly secured into the hole of the mouthpiece device.
• Remove plastic cap from MDI mouthpiece.
• Shake the MDI canister to mix the medicine and propellant.
• Holding the MDI upright, exhale (breathe out). Open your mouth and hold the MDI about an inch away from your lips.
• Begin to breathe in and as you do so, press down on the canister (releasing medicine/puff) and continue to breathe in slowly and completely.
• It is also possible to use your MDI by placing the device in your mouth. Please your lips around the mouthpiece and perform the maneuver as above.
• Hold your breath for up to 10 seconds to allow the medicine to reach deep into your lungs.
• Slowly breathe out.
• Repeat steps 1-12 if your doctor has ordered more than one puff
• Put cap back onto the inhaler.
• Keep your mouthpiece and spacer clean as a dirty mouthpiece and/or spacer can cause infections.

• To clean the inhaler (exceptions Qvar, see below), remove the metal canister from plastic mouthpiece sleeve. Wash the mouthpiece sleeve with warm soapy water, rinse with warm water and dry it thoroughly before reusing. Do not submerge or wash the metal canister since water may damage the valve system.
•  For the Qvar inhaler: the mouthpiece of your inhaler should be cleaned weekly with a clean, dry tissue or cloth. Do not wash or put any part of your inhaler in water.

*Maxair Autohaler works a bit differently than the standard MDI. Please refer to the web site for complete detail

Helpful MDI Tips

• Practice these steps for using your MDI. It can be helpful to practice in front of a mirror. To make sure you are following the steps correctly, ask your doctor or respiratory therapist to watch you use your MDI.
• Blowing out all of your air in your lungs (exhaling), before breathing in your puff of medicine, will help you take in a deeper breath, and this helps to get more medicine deep into your lungs.
• It is recommend that you use a spacer or holding chamber because it is much easier to correctly coordinate the spray of the medication.
• If your MDI is new or you have not used it in 24 hours you should “prime’ (spray one dose into the open air) the MDI to make sure you get the full dose of medicine.
•   Some inhaled medicine can make your mouth sore, so after you have finished using your inhalers rinse out your mouth with water. Spit out water; do not swallow the water. This is especially important if you are using inhaled steroids i.e. Flovent®, Beclovent®, Vanceril®, Aerobid®, or Azmacort® to prevent fungal growth in your mouth.
• The only way to be sure that you have medication left in the MDI is to count each time you use you MDI. Each MDI contains a specific amount of sprays/puffs; you can find this number in the drug insert that comes with your MDI. There are several types counter devices that attach to your MDI that will keep count of puffs. Ask to see them at your pharmacy.
• Do not puncture the canister.
• Do not store canister in temperatures over 120 F. i.e. car trunks, glove boxes and/or in the direct sunlight.

How to Use Your DPI

• Wash your hands.
• Remove cap or cover.
• Place your teeth on the mouthpiece and seal your lips around it. Make sure your tongue is not blocking the mouthpiece.
• There are several different types of DPI’s and you should follow the recommended steps to load in the medicine and release the medicine.
• Advair DISKUS®
• Amanex Twisthaler®
• FORADIL® AEROLIZER®
• Plumicort Turbuhaler®
• Rotahaler
• Serevent Diskus
• Spiriva Handihaler®

• Breathe in quickly and deeply through your mouth. This activates the flow of medicine.
• Take your mouth off of the mouthpiece and hold your breath for up to 10 seconds and then exhale.
• Slowly breathe out.
• Repeat steps 1-7 if your doctor has ordered more than one puff.
• Keep your DPI mouthpiece clean. Clean the mouthpiece at least once a week using a dry cloth. Do not wash your dry powder inhaler. You can make sure to thoroughly wipe away any particles of powder that have collected on the mouthpiece.

Helpful DPI Tips

• Blowing out all of your air in your lungs (exhaling), before breathing in your puff of medicine will help you to take in a deeper breath, and this helps to get more medicine deep into your lungs.
•  Do not blow into your DPI as it could clog the DPI. If the valve is clogged you will not get all of the medicine.
• If you breathe into the DPI after you have released the medicine, repeat steps 1 –7.
• Some DPIs require you to put a pill or capsule into your DPI device. Make sure that you place the capsule or pill into your inhaler device and DO NOT swallow the pill or capsule.
• You do not need to shake your DPI before use.

How to Use Your Nebulizer

• Wash your hands.
• Place your medicine in the nebulizer cup
• Turn on the machine. A mist will start to form.
• Breathe in normally and every 10 breaths take in a deep breath and hold it for 5 to 10 seconds.  To make sure you get all of your medication into your lungs, be sure you are breathing through your mouth. Sometimes it is helpful to use nose clips.
• A nebulizer treatment should last about 10 minutes or until the mist is gone.
• A dirty nebulizer can make you sick, so it is important to keep your nebulizer clean.
• After the treatment, remove the nebulizer from the tubing and then take apart the mouthpiece or facemask, and tubing if present, and nebulizer cup.
• Empty out the nebulizer cup, rinse out the cup with water, shake off excess water, and place on paper towel to dry.
• At the end of the day wash the nebulizer cup and mouthpiece or facemask in warm soapy water (a mild dishwashing liquid is a good choice). Rinse the soap completely off of the equipment and place on a clean paper towel to dry.
• Disinfect your nebulizer cup and mouthpiece/mask at least once a week using either a vinegar/water solution or the disinfectant solution your equipment supplier suggests.

 

Helpful Nebulizer Tips

• If a mist does not form:     
• First check to see if the machine is plugged into electrical outlet or if you are using a portable device, make sure battery is charged.
• Make sure that the tubing is securely connected to the nebulizer machine and nebulizer cup.
• Inspect the tubing for bends or kinks, check the nebulizer cup for cracks, and/or clean the nebulizer machine’s air filter.
• If these actions do not correct the problem, call the place where you purchased the nebulizer machine or the nebulizer machine manufacturer for further help.

Understand your Medicines

Ask your doctor and/or respiratory therapist what the name of your medication is, how often you are to use your medication, how to properly use your medicine device and whether the medicine is for control/maintenance or rescue/fast-acting. It is very important to understand the action of the two types of medicines because they behave in much different ways. Using the wrong type of medicine can be a deadly mistake.

Maintenance/Control Drugs

Maintenance/control drugs work slowly over time and will NOT help you if you are experiencing sudden shortness of breath or other serious breathing symptoms. These types of drugs are to be taken every day, even if you are not experiencing shortness of breath.

Rescue/Fast Acting Drugs

Rescue/fast-acting drugs provide fast relief for sudden or increased shortness of breath. For people who have exercised-induced asthma, this type of drug is often taken before you exercise.

 

 When to Call Your Doctor

• If it is an emergency call 911
• If you are having any signs or symptoms of a respiratory flare-up: For further information see Flare-ups
• Increased shortness of breath
• Not feeling well, your usual daily activities may be more tiring and require more physical effort.
• Increased amount of mucus. It may also be thicker and greenish in color.
• Increased need for lung medication
• Recent viral or bacterial infection
• Wheezing
• Exposure to high pollution levels
• Exposure to irritants, i.e. chemicals, smoke, dust, etc.
• Fever
• If you, or others, see changes in your “normal” breathing: slow, shallow, rapid, difficult, and/or irregular breathing.  
• Unusual and/or frequent headaches
• You, or others, see a blue tint to your lips or fingernails
• Increased drowsiness
• Onset of confusion
• Increased level of restlessness
• Unexplained anxiousness and/or anxiety