Giving medication through a meter dose inhaler

At the end of this chapter, you will:

• demonstrate how to use a metered dose inhaler
• understand how to clean and maintain a metered dose inhaler

Inhaled respiratory medications can be given with a metered dose inhaler (MDI) using a spacer device. This is a plastic tube that suspends the medication inside until the child breathes in. An example of a spacer device is an AeroChamber.

Your child’s health-care team will determine which is the best way to deliver the medication.

An MDI is also known as a “puffer”. It is a pressurized canister that contains medication. When the canister is pushed down, the medication becomes a fine spray which could then be inhaled by the child.

In order to give your child the medication, you will need:

• MDI (medication)
• spacer or valve-holding chamber. This helps hold the medication until your child breathes it in

How to prime the metered dose inhaler canister

Prime your inhaler if:

• this is the first time you are using it
• you have not used it for several days
• you have dropped it

When to prime an inhaler can also vary with different medications. Please see the instructions provided with the inhaler or speak with your child’s pharmacist or health-care provider.

Priming an MDI usually involves shaking it and spraying it into the air (away from your face) a total of up to four times.

How do I use the meter dose inhaler (MDI) to give medication to my child with a tracheostomy tube?

1. Remove the cap from the MDI.
2. Shake the MDI well before each puff.
3. Keep the MDI upright and insert it into the backpiece of the spacer. Carefully attach the spacer directly to the tracheostomy tube.
4. As your child breathes in, press down on the MDI canister to release a puff of medication into the spacer.
5. After this first puff, keep the spacer attached to the tracheostomy tube while your child takes at least six breaths or breaths in and out for at least 10 to 15 seconds.
6. Spray only one puff into a spacer at a time. If multiple puffs are prescribed, wait 10 to 15 seconds (about 6 breaths) before removing the MDI and repeating the procedure. Shake the MDI well before each puff.

Note: Make sure to keep a dose tracker to ensure that your MDI has not run out. Because an MDI has a propellent, it may look and sound like there is still medication when it has run out.

How do I clean the spacer?

Wash the spacer before using it for the first time, and then once a week after that. Clean more often as needed. Always check the manufacturer's instructions.

1. Remove the backpiece (the rubber back piece that lets the MDI fit in) from the spacer. Do not remove the adapter assembly.
2. Soak the adapter and the spacer in lukewarm water with mild dish detergent for 15 minutes. Do not wash your child’s spacer in a dishwasher.
3. Gently shake both parts so soapy water can get into all the parts.
4. Rinse both parts in clean water.
5. Shake off excess water. Do not use a towel.
6. Stand the spacer up in an upright position and let it air dry.
7. Put the adapter back onto the spacer when both parts are completely dry.