Using a Metered Dose Inhaler (MDI)

Using your MDI correctly is essential for getting your full asthma medication dosage

Different metered-dose inhalers (MDIs) look the same on the outside, but each is distinctly different in operation and maintenance.

You must inhale the spray quickly enough to prevent it from landing on your tongue or inside your cheek, yet slowly enough to let it get deep into your lungs.

Using a Metered Dose Inhaler: with a Spacer

Using a Metered Dose Inhaler: one to two inches from Mouth

Using a Metered Dose Inhaler: (inhaler in mouth)

Using a Metered Dose Inhaler: Open-Mouth Technique

Step-by-Step Instructions

1. Remove the MDI mouthpiece cap and look at the tiny exit hole where the medication comes out of the canister. It should be free of debris or white powder. If it’s not, follow package instructions to thoroughly clean the inhaler.
2. Shake the inhaler if instructed in your patient information sheet. This will mix the crystalline powder medication with propellants and other ingredients inside the canister to ensure the right blend. Note: A few brands of MDI (including Alvesco and QVAR) are blended differently and don’t need shaking.
3. Prime the inhaler if necessary. When the MDI is new and never been used or hasn’t been used in a while, the ingredients may separate. Priming (releasing the required number of sprays into the air) before use ensures the dose you inhale contains the labeled amount? of medication.    (Note: When using a valved holding chamber, prime the MDI before inserting the MDI mouthpiece into the end port of the chamber.)
4. Stand or sit up straight and breathe out completely. Empty your lungs as much as possible to give you room to inhale the medication slowly and deeply.
5. Hold the inhaler upright with the mouthpiece at the bottom and the top pointing up. Position it as instructed by your physician or the medication’s patient instruction sheet. Some recommend holding the inhaler about 1-2 inches away from your open mouth; others recommend putting the MDI mouthpiece between your teeth and closing your lips tightly around it. Be sure to keep your tongue out of the way of the spray.     (Note: Studies show that using a valved holding chamber with your MDI can help increase the amount of medication that gets into your lungs by directing and suspending the medication long enough for you to inhale. After inserting the MDI into the chamber’s port, hold the unit with the top of the MDI canister pointed up. Put the chamber’s mouthpiece between your teeth and close your lips tightly around it. If using a mask, place it tightly over mouth and nose to create a suction hold. Activate the inhaler and inhale.
6. Begin to inhale slowly, then activate the inhaler a split-second later. If you wait too long, you won’t have enough breath left to inhale the medicine deep into your small airways.
7. Continue inhaling slowly for 3-5 seconds, until your lungs are full.     (Note: You might be surprised at how long 3-5 seconds is, so test yourself. Using a stopwatch device or clock with a second hand, begin to inhale and pretend to actuate your inhaler. See how long it takes you to fill your lungs. Did you run out of room in your lungs before 3 seconds? If so, try it again, more slowly. Practice until you’re able to get it right. Then practice again…and again. Some holding chambers featurs a whistle that goes off if you are inhaling too forcefully, a signal that you need to slow down. )
8. Exhale slowly.
9. Hold your breath for 10 seconds, if possible. (You can take the inhaler out of your mouth.) When you hold your breath, you allow the tiny particles of medication to settle on the surface of your airways.
10. Repeat steps 2 through 9 if your Asthma Action Plan says to take a second dose. (Skip step 3; your inhaler would not need to be primed again so soon.)
11. Replace the cap on your inhaler and store it where it won’t be exposed to moisture or extreme temperature changes. Check your patient instruction sheet to see if your inhaler needs to be stored in an upright position; some do.     (Note: For best results, store and use the inhaler at normal room temperature – about 77 degrees F. In very cold weather, keep it close to your body, not in your car or in a backpack. If necessary, warm the inhaler with your hands before using it.)
12. Clean the inhaler according to its patient instructions, usually weekly. If using water, leave time for the inhaler to air dry. Holding chambers also need to be washed according to instructions.

Patient education resources from Allergy & Asthma Network

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Last updated : 12/11/2020