Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

Metered Dose Inhalers

Metered dose inhalers (MDI), or puffers, deliver a precise dose of medication to the airways when used appropriately. It is very important to have a good technique. A holding chamber or spacer is recommended for use with a MDI, particularly for those not able to use a puffer accurately. To tell if the puffer is empty:

  1. Calculate the number of doses used, or
  2. Invert or shake it close to the ear several times and listen/feel for movement of liquid. One advantage of using the MDI is that it is quite portable. A number of different metered dose inhalers are available. Different pharmaceutical companies manufacture similar medications that are in different inhalers.

Metered Dose Inhaler: Proper Use

  1. Remove the cap from the mouthpiece and shake the inhaler.
  2. Breathe out to the end of a normal breath.
  3. Position the mouthpiece end of the inhaler about 2-3 finger widths from the mouth,  open mouth widely and tilt head back slightly, OR b)Close lips around the mouthpiece and tilt head back slightly.
  4. Start to breathe in slowly, and then depress the container once.
  5. Continue breathing in slowly until the lungs are full.
  6. After breathing in fully, HOLD breath for 10 seconds or as long as possible, up to 1 second.
  7. If a second puff is required, wait one minute and repeat the steps.

Care of a Metered Dose Inhaler

  • Keep the inhaler clean.
  • Once a week, remove the medication canister from the plastic casing and wash the plastic casing in warm, soapy water.
  • When the casing is dry, replace the medication canister in the casing and place the cap on the mouthpiece.
  • Ensure that the hole is clear.
  • Check the expiry date.
  • Check to see how much medication is in the inhaler as described in the previous section.