Patient education: How to use your child's metered dose inhaler (The Basics)

Do I need to do anything to get my child's inhaler ready? — Yes. Before you use a metered dose inhaler for the first time, you need to get it ready. This is called "priming." To do this, you:

●Take the cap off the mouthpiece

●Shake the inhaler for 5 seconds (picture 1)

●Press down on the canister to spray the medicine into the air (away from your face)

●Repeat these steps 1 to 3 more times, depending on the type of inhaler

If your child hasn't used the inhaler for more than a few days to weeks, depending on the type of inhaler, you need to follow the steps above before using the inhaler again. Check the instructions or ask your child's doctor or pharmacist about when you need to prime your child's inhaler.

After the inhaler is ready, your child can use it as prescribed.

How should my child use the inhaler? — Each inhaler has its own directions. Your doctor or nurse will show you how your child should use their inhaler.

Almost all children with asthma use an inhaler with a "spacer." A spacer is a device that attaches to the inhaler's mouthpiece (picture 2). Pressing down on the canister causes the puff of medicine to spray into the spacer, then the person breathes it in. Some spacers also come with a face mask.

In general, to use your child's metered dose inhaler, you:

●Take the cap off the mouthpiece and put the inhaler in the spacer

●Shake the inhaler for 5 seconds

●Hold the inhaler upright with 1 finger on the top of the canister, the thumb on the bottom of the inhaler, and your other hand holding the spacer

●Have your child breathe out normally

●Have your child close their lips around the mouthpiece of the spacer (figure 1). If the spacer has a face mask, hold the face mask snugly over your child's mouth and nose.

●Press down on the canister

●Have your child take a deep, slow breath in, then hold it for 5 to 10 seconds. Have your child let the breath out, then breathe in deeply and slowly and hold their breath again. If a mask is used, have your child breathe in and out normally for 10 seconds instead of taking a deep breath and holding it.

●If your child is supposed to take 2 puffs of the inhaler, wait 15 to 30 seconds before you give the second puff. Shake the inhaler again before the second puff.

●Remove the inhaler from the spacer and put the cap back on the mouthpiece, or leave the inhaler in the spacer for the next use

●If the inhaler is a steroid medicine (also called a "glucocorticoid" or "corticosteroid"), have your child rinse out their mouth, gargle, and spit out the water

Do I need to clean the inhaler? — Yes. If your child uses the inhaler every day, you need to clean it at least once a week. If your child doesn't use the inhaler every day, you can clean it less often. To know when you need to clean it, look inside the mouthpiece. Clean the inhaler when you see powder in or around the hole.

To clean an inhaler, you:

●Remove the canister and cap from the mouthpiece. Do not wash the canister or put the canister under water.

●Run warm water through the mouthpiece for 30 to 60 seconds

●Shake the water off of the mouthpiece and let it air dry

Do I need to clean the spacer? — Yes. If your child uses the spacer each day, you should clean it every 1 to 2 weeks. First, remove the inhaler from the spacer. Wash the spacer with warm water and dishwashing soap, but do not rinse it. Then let it air dry. Leaving the spacer a little soapy after cleaning actually helps it work better.

If your child uses an InspirEase chamber every day, replace the bag every 1 to 2 weeks or right away if there is a hole in the bag (picture 2). Clean the mouthpiece in warm running water and let it air dry. Do not wash the bag.

How do I know if my child's inhaler is empty? — Some inhalers come with a built-in dose counter (picture 3). A counter keeps track of how many doses are left in the inhaler.

When the counter reads 0 (zero), it's time to throw out the inhaler. That's because there is no more medicine in it. Make sure to have another inhaler on hand before the counter reads 0.

If the inhaler doesn't have a built-in counter, you need to keep track of the number of doses left in it. Based on how often your child uses the inhaler, you can figure out when they will need a refill and write this date down.

More on this topic

Patient education: Asthma in children (The Basics)
Patient education: How to use your child's dry powder inhaler (The Basics)
Patient education: Medicines for asthma (The Basics)
Patient education: Exercise-induced asthma (The Basics)

Patient education: Asthma inhaler techniques in children (Beyond the Basics)
Patient education: Asthma treatment in children (Beyond the Basics)