The albuterol metered-dose inhaler (MDI) is a handheld device that delivers a precise, measured amount of medication directly into the lungs. This medication is a fast-acting bronchodilator, meaning its primary function is to relax the muscles around the airways, causing them to open quickly. Proper technique when using this rescue inhaler is paramount because it ensures the medication reaches the lower airways, where it can most effectively relieve symptoms of asthma or Chronic Obstructive Pulmonary Disease (COPD). Without correct technique, most of the albuterol may deposit in the mouth and throat, limiting its therapeutic effect on the lungs.
Step-by-Step Guide to Inhaler Use
The process begins with preparing the device. Check the dose counter, then vigorously shake the canister for about five seconds to mix the medicine and its propellant. If the inhaler is new, unused for over two weeks, or dropped, it must be “primed” by spraying a few puffs into the air, away from your face.
Before placing the device in your mouth, sit or stand up straight and exhale completely to empty your lungs. This creates maximum space for the subsequent deep breath of medication. Position the inhaler by either sealing your lips tightly around the mouthpiece, or by holding it one to two inches away from your open mouth.
Start to inhale slowly and deeply through your mouth, simultaneously pressing down on the canister once to release the medication. This synchronization is crucial, and the inhalation should continue slowly for three to five seconds. After the full breath is taken, remove the inhaler and hold your breath for up to 10 seconds, or for as long as is comfortable. Holding the breath allows the medication particles time to settle deep within the airways.
Finally, exhale slowly through your nose or pursed lips. If a second puff is necessary, a mandatory waiting period of one minute is required before repeating the entire sequence of steps, starting with shaking the inhaler again. This pause allows the first dose to begin opening the airways, potentially allowing the second puff to penetrate even deeper into the lungs.
The Role of Spacers and Holding Chambers
A spacer, often called a valved holding chamber, is a hollow tube that attaches to the MDI mouthpiece and serves as a reservoir for the medication. Using a spacer is highly recommended because it simplifies the technique, particularly by eliminating the need to coordinate the canister press with the start of inhalation. The chamber holds the aerosolized medication for a few seconds, giving the user more time to inhale the dose.
When using a spacer, the inhaler is prepared and shaken as usual, then inserted into the rubber ring on one end of the device. After exhaling fully, the user presses the canister once to discharge the medication into the chamber. Immediately place your lips tightly around the spacer’s mouthpiece and begin to breathe in slowly and deeply.
One deep, slow inhalation from the spacer is often sufficient, followed by the usual 5- to 10-second breath hold. For individuals who have difficulty taking a single deep breath, such as young children or the elderly, the technique can be modified to involve taking several slow, steady breaths immediately after the puff is released into the chamber. Some valved spacers even include a built-in whistle that sounds if the user inhales too quickly, providing immediate feedback to slow the breath down.
Essential Maintenance and Storage
Maintaining the MDI’s plastic actuator is important for reliable drug delivery, as residue can build up and block the spray opening. The plastic actuator should be cleaned at least once a week. First, remove the metal canister, as it must not get wet, then rinse the plastic piece under warm, running water for about 30 seconds, allowing water to flow through the top and the mouthpiece.
No soap, detergent, or scrubbing should be used on the actuator, as these can interfere with the medication delivery. After rinsing, shake off any excess water and allow the plastic piece to air-dry completely, ideally overnight, before reinserting the canister. If the inhaler must be used before it is fully dry, shake off the water and prime it with two test sprays into the air before taking a dose.
For storage, the inhaler should be kept at room temperature, as extreme heat or cold can affect the propellant and effectiveness. Always keep the protective cap on the mouthpiece between uses to prevent dust or foreign objects from getting lodged inside. Monitoring the dose counter is necessary, and the inhaler must be replaced when the counter reaches zero.
Troubleshooting Common Usage Mistakes
One of the most frequent errors is inhaling too quickly or too forcefully, which causes the medication droplets to settle in the back of the throat instead of traveling deep into the lungs. The inhalation speed should be slow and steady. Failing to shake or prime the inhaler is also a common mistake, resulting in a dose that may contain an uneven or insufficient amount of medication.
Users often forget to fully exhale before starting the inhalation, reducing the capacity in the lungs to draw in the full dose effectively. Not holding the breath for the recommended time is a significant error, as this reduces the amount of time the particles have to deposit in the airways. Taking multiple prescribed puffs without waiting a full minute between each one limits the penetration of the second dose, as the first dose has not yet initiated airway opening.