A rescue inhaler, formally known as a Metered-Dose Inhaler (MDI), is a medical device designed for the rapid treatment of acute breathing distress, most commonly associated with asthma. It contains a pressurized canister that delivers a precise dose of medication, typically a short-acting bronchodilator like albuterol. The medication works quickly by relaxing the smooth muscles surrounding the airways, a process called bronchodilation. This action opens constricted airways, rapidly relieving symptoms such as wheezing, chest tightness, and shortness of breath during an asthma attack.
Step-by-Step Guide for Proper Use
Proper technique is necessary to ensure the medication reaches the lower airways where it can be most effective. Begin by removing the cap and shaking the inhaler vigorously for about five seconds to ensure the medicine and propellant are thoroughly mixed for a consistent dose. If the inhaler has not been used recently, it may require priming by spraying a test puff into the air; check the manufacturer’s instructions for the specific priming process.
Next, exhale slowly and completely to create space for the inhaled medicine. Hold the inhaler upright, placing the mouthpiece between your teeth and sealing your lips tightly around it to prevent the mist from escaping. Coordinating the next two steps is crucial for optimal drug delivery, as they must happen almost simultaneously.
As you begin to inhale slowly through your mouth, press down firmly on the top of the canister to release a single puff of medication. Continue this slow, deep breath for three to five seconds until your lungs feel full. Remove the inhaler from your mouth and hold your breath for up to ten seconds, allowing the medication to settle deep within the lung tissue. If a second puff is prescribed, wait at least 30 to 60 seconds before repeating the entire sequence, starting with shaking the inhaler again.
Adapting Technique When Using a Spacer
A spacer, or valved holding chamber, is a hollow tube that attaches to the MDI mouthpiece and is recommended to improve medication delivery into the lungs. Using a spacer significantly reduces the need for coordination between pressing the canister and inhaling the dose. This accessory captures the medication mist, slowing its velocity and allowing the patient more time to breathe it in.
To use an MDI with a spacer, first shake the inhaler and insert it firmly into the rubber ring at the end of the spacer. After exhaling fully, place the spacer’s mouthpiece in your mouth and seal your lips around it. If using a pediatric or mask-equipped device, ensure the mask sits snugly over your nose and mouth. Press the canister once to release the medication into the chamber.
You can use one of two breathing techniques: the single-breath-and-hold method or tidal breathing. For the single-breath method, immediately begin a slow, deep inhale from the spacer, aiming to hold your breath for ten seconds afterward. A whistling sound indicates you are inhaling too quickly, and you need to slow your breath down. Alternatively, the tidal breathing technique involves taking five to six normal, steady breaths from the spacer, which is helpful for young children or individuals unable to hold their breath.
Device Maintenance and Monitoring Doses
Regular maintenance of the MDI is necessary to prevent clogs and ensure the device is ready for an emergency. At least once a week, clean the plastic actuator, which is the L-shaped casing that holds the metal canister. Remove the canister and set it aside, as it must never be exposed to water.
Rinse the plastic casing and cap thoroughly under warm running water for about 30 seconds, allowing water to run through the mouthpiece opening. Do not use soap or detergent unless instructed by the manufacturer. Let the casing air dry completely overnight before reinserting the metal canister. Store the MDI at room temperature, as extreme heat or cold can affect the pressure within the canister and alter dose delivery.
Many modern MDIs include a dose counter on the canister to monitor the remaining puffs. If your inhaler lacks this feature, manually track the number of puffs used from the total number indicated on the label. Never attempt to use the outdated “float test,” which involves placing the canister in water, as this method is inaccurate and may give a false reading of the medication level.
Recognizing When to Seek Emergency Care
A rescue inhaler is the first line of defense, but failure to resolve symptoms indicates a severe medical situation requiring immediate professional help. If breathing distress does not significantly improve after using the maximum prescribed initial dose, initiate emergency protocols. The standard recommendation is two to four puffs every 20 minutes, up to a total of three treatments, though a severe attack may require escalating to as many as ten puffs.
If symptoms worsen at any point, or if you do not see improvement after the third set of doses, call emergency services immediately. Warning signs of a medical crisis include:
- Difficulty speaking in full sentences.
- A bluish tint to the lips or nail beds.
- Confusion.
- Agitation.
Do not hesitate to call for help, as waiting too long can lead to respiratory failure, a life-threatening complication.