Taking your inhaled medications correctly is an important part of asthma treatment. The medication goes directly into your lungs, where it is needed, so it is quite effective and causes few side effects.
There are 3 devices for taking inhaled medicines:
- Metered dose inhalers (MDIs). These inhalers deliver medicine as a spray and are usually used with a spacer that holds the medication. A spacer is a device that holds the medicine after it is released by the inhaler. That makes it easier to get the medicine directly into your lungs.
- Dry powder inhalers (DPIs). These inhalers deliver medicine as a powder. They are used without a spacer.
- Nebulizers. These machines deliver quick-relief medicine or inhaled corticosteroids as a fine mist.
Using your metered dose inhaler (MDI) with a spacer
- Metered dose inhalers (MDIs) are sometimes called "inhalers" or "puffers."
- Your MDI works best when used with a spacer.
- Spacers increase the amount of medicine that gets into the lungs and can help prevent side effects.
- Less medicine ends up in your mouth and throat.
- It is also easier to use an MDI with a spacer because you do not have to coordinate puffing with breathing.
How to use your MDI
It is important to use your metered dose inhaler and spacer correctly in order to get the medication into your lungs. When using your MDI and spacer be sure to:
- Stand up straight.
- Take the cap off the inhaler.
- Hold the inhaler upright and shake it well.
- Insert the mouthpiece of the inhaler in the spacer.
- Breathe out normally, emptying your lungs. Remove the cap from spacer.
- Place the mouthpiece of the spacer in your mouth between your teeth, with your tongue underneath. Make sure that your lips make a tight seal around the mouthpiece.
- Press down once on the medicine canister, releasing one puff or dose of medicine into the spacer. Do not release more than one puff at a time.
- Breathe in slowly and deeply from the spacer. Fill your lungs with as much medicine and air as possible.
- Take the spacer out of your mouth and hold your breath.
- Slowly count to 10 while you hold your breath.
- Breathe out slowly through your mouth.
- If you are taking more than one puff of medicine, it may help to wait one minute or more between puffs.
- When you are done taking the medicine, remove the inhaler from the spacer and replace the cap on the mouthpiece of the inhaler.
- Rinse your mouth with water if you are using an inhaled steroid (for example, QVAR or Flovent).
We will check the way you use your inhaler and spacer together to make sure you are using them correctly.
Make sure there is medicine in your MDI
Keep track of how much medication you use so that you will know when your inhaler is almost empty. Do not float your inhaler in water to see how much medication is left. This does not work. Use this method:
- Make a check mark each time you take a puff. When the number of check marks equals the number of puffs in your inhaler, your inhaler is empty. Be sure to refill your medications when you are down to a two-week supply.
- Another method is to divide the number of puffs in the canister by the number of puffs used each day. This will give you the number of days the medication will last. Mark this day on your calendar and plan ahead to replace your inhaler before this day comes.
Cleaning and caring for your MDI and spacer
- Hand-wash the inhaler's plastic holder and spacer with mild soap and warm water at least once a week. (Take the canister out of the plastic holder before you wash it.)
- Let them air dry.
- Do not put an inhaler or spacer in the dishwasher.
Using a dry powder inhaler (DPI)
Dry powder inhalers deliver medicine as a powder. They are used without a spacer. To use a dry powder inhaler, you need to be able to breathe air in quickly and deeply. There are several types of dry powder inhalers.
Diskus dry powder inhaler
Follow these steps:
- Stand up straight.
- Do not blow into the DPI.
- Release a dose of medicine into the inhaler chamber according to the instructions for your DPI. Do not release more than one dose at a time.
- After you have released the medicine, be sure not to turn the DPI over because the medicine might fall out.
- Breathe out first and then put your mouth completely over the inhaler opening.
- Breathe in the dry powder quickly and deeply.
- Hold your breath for 10 seconds.
- When you are done taking the medicine, close the inhaler.
- Rinse out your mouth after using your DPI.
Check how many puffs are left in your DPI
- The diskus contains 60 doses of medication.
- It has a dose indicator that counts down the number of doses as you use them.
- Doses 5 through 0 are red to alert you to refill your prescription.
- When the "0" appears in the dose indicator, throw away the diskus and begin a new one.
Be sure to refill your medications when you are down to a two-week supply.
Cleaning and caring for your DPI
It is important to keep your dry powder inhaler clean and dry.
- Use a cloth to wipe the mouthpiece after each use and store your inhaler in a dry place.
- Do not store a dry powder inhaler in your bathroom. Although the bathroom might seem like a dry place, it is not. A kitchen cupboard or other dry place is a better choice.
Twisthaler dry powder inhaler
Follow these steps:
- Remove from foil pouch and write date on the cap label.
- Hold inhaler up with base (pink) on the bottom.
- Take off cap while in this upright position to get the right amount of medicine with each dose.
- Hold the base and twist the cap counterclockwise to remove it. This action loads the medicine.
- The dose counter on the base will count down by 1. It is found just below the indented arrow (in the pink portion).
- Exhale completely. Bring the Twisthaler to your mouth with the mouthpiece facing toward you.
- Put the mouthpiece in your mouth and firmly close your lips around it.
- Take a fast, deep breath.
- Remove the Twisthaler from your mouth and hold your breath for 10 seconds.
- Do not breathe out through the inhaler.
- After taking your medicine, wipe the mouthpiece dry and replace the cap, firmly closing the Twisthaler.
- To close, gently press down and turn the cap clockwise. When you hear a click, the cap is fully closed.
- Rinse and spit after taking your medication.
- Repeat these steps if more than one puff is prescribed.
Check how many puffs are left in your Twisthaler
- The Twisthaler has a dose counter on the pink base.
- When the counter displays 01, there is one dose left.
- If the counter displays 00, there is no medicine left and the cap will lock.
The manufacturer recommends discarding the inhaler 45 days after opening the pouch or when the dose counter reads 00, whichever comes first.
Be sure to refill your medications when you are down to a 2-week supply.
Cleaning and caring for your Twisthaler
- Keep your inhaler clean and dry at all times.
- If the mouthpiece needs cleaning, gently wipe the mouthpiece with a dry cloth or tissue.
- Do not wash the inhaler. Avoid contact with any liquids.
- Store in a dry place.
- Keep your inhaler out of the reach of children.
Using a nebulizer
A nebulizer is a machine that administers medication in the form of a mist inhaled into the lungs.
- Nebulizers may be used in the clinic or emergency room to give a person with asthma a 5 to 15-minute breathing treatment.
- They are also used at home for people who cannot use an inhaler with a spacer.
- Compared to using an inhaler, nebulizers are bulky and less convenient.
You will find that taking 4 to 6 puffs of quick-relief medicine from an inhaler with a spacer works just as well as a breathing treatment with a nebulizer. When you visit the clinic, we can observe if you are using your inhaler and spacer correctly.
Follow these steps to give yourself a nebulizer treatment:
- Place the nebulizer on a flat surface.
- Plug the unit into an outlet.
- Connect the tubing to the nebulizer machine.
- Put the medication into the nebulizer cup and screw the cap on securely.
- Connect the other end of the air tubing to the nebulizer cup.
- Connect the mouthpiece or face mask to the nebulizer cup.
- When you turn the machine on, check to make sure that a fine mist of medication is coming through the face mask or mouthpiece.
- Place the mouthpiece in your mouth with the lips sealed around the mouthpiece. Another alternative is to place the face mask over your mouth and nose. The elastic band will hold the mask in place.
- Take slow, deep breaths until all the medication in the nebulizer cup is gone.
- You may need to tap the sides of the nebulizer cup to ensure that all medication is given before you turn off your nebulizer.
Caring for and cleaning your nebulizer
- Disconnect the nebulizer cup from the tubing.
- Open the cup and wash and rinse all pieces with mild dish soap and water. Do not wash or rinse the tubing.
- Air dry your nebulizer on a clean towel.
- Store the dried nebulizer cup and tubing in a plastic bag.
- Once a week rinse the nebulizer cup in one part vinegar mixed with one part water after washing. Rinse again and allow to air dry.