Inhaled Medications are the state-of-the-art medications for asthma as they deliver the medication locally and directly to the airways, the site of the problem. The use of inhaled medications is preferred, whenever possible, because the chance of side effects throughout the body is significantly less by this route. There are a number of types of delivery devices and the proper technique of use is essential for a young child to have the maximum benefits from the medication. Believe it or not, many times, asthma control is poor just because the technique of inhalation is improper. In this section, we will explain/outline the different delivery device options and show you a video, as well as give you an explanation that will teach you about the correct use for future reference.
Metered Dose Inhaler (MDI):
An MDI, or Metered Dose Inhaler, is a metal canister containing medication in an aerosol form. The canister is inserted into a plastic case (known as an activator) and when the top of this canister is firmly depressed, it delivers one "puff" of aerosol medication. The following is the proper techniques to assure that you are getting the most medication with each puff delivered.
1. Shake canister well to mix medication before each use. Make sure canister is firmly inserted into activator with a straight downward push into opening at bottom of activator. DO NOT TWIST CANISTER INTO PLACE. When using MDI for the first time, spray 4 puffs into air, making sure that all connections are tight. (You should see a fine mist being sprayed into the air).
2. Breathe fully out to completely empty lungs.
3. Without breathing in, place mouthpiece into mouth and behind teeth. Close lips tightly around the mouthpiece.
4. Simultaneously, that is, the MOMENT you begin to breathe in, depress the canister top firmly with you index finger and continue breathing in DEEPLY AND SLOWLY until lungs are completely expanded.
5. HOLD BREATH-with canister still inside mouth-and count to eight.
6. Before breathing out, gently and slowly remover MDI from mouth.
7. Wait at least one minute before delivering next puff of medication. With each puff to be delivered, follow steps one to six as above.
Through a spacer:
A spacer is a hollow device that is attached to a metered dose inhaler. The spacer provides a place for the medication to slow down before inhalation. When medication particles move slowly, the amount of medication delivered to the lungs increases instead of impacting at the back of the throat. Delivering medication by this method increases its effectiveness and decreases side effects. A spacer makes it easier for your child to inhale the medication because the spacer traps the medication until your child had completed inhaling.
How to use a spacer with a MDI:
1. Examine the spacer to be sure there are no foreign objects inside.
2. Attach the MDI to the spacer.
3. Shake the MDI while attached to the spacer
4. Have your child exhale fully.
5. Place mouthpiece in mouth and close lips tightly around it.
6. Depress canister, thereby giving one dose of medication, usually called a puff.
7. Have your child inhale slowly and deeply.
8. With mouthpiece still in mouth, have your child hold their breath for 8 to 10 seconds, as tolerated.
9. After this time, your child removes spacer, breathes normally and waits the necessary time between puffs (usually one minute).
10. For next puff, repeat steps 3 through 9.
11. Frequently check MDI for fullness and spacer valve leaflets for any sign of curling. Many new MDIs have counters on them so that you can easily see how many puffs or inhalations are left before the canister is empty. Alternatively,
A) If your child uses their inhaler daily, you can multiply the number of puffs used in one day times seven days and have a general idea of how many puffs have been used in a week. The MDI canister is labeled with the number of inhalations it contains. Use this number as a guideline. Note on your calendar one or two weeks in advance of the time you will need a refill of this medication. Discard the canister after you have used the labeled number of inhalations. The correct amount of medication in each inhalation cannot be guaranteed after this point.
B) Note the expiration date of the canister and do not use after that date.
C) Replace spacer when inside valve leaflets begin to curl.
Cleaning Spacer:
Spacer should be cleaned on a regular basis following manufacturer's instructions.
Through a spacer with a mask:
1. Examine spacer to be sure there are no foreign objects inside.
2. Attach the MDI to spacer.
3. Shake the MDI while attached to the spacer.
4. Place the mask over your child's nose and mouth.
5. Depress canister, thereby giving one dose or puff of medication.
6. With mask in place, have your child take 5-6 breaths. Parents, please be aware that if your child is crying or screaming, he or she is still inhaling, thereby receiving the medication. If your child is crying, count the approximate time it would take for 5-6 breaths.
7. After this time, remove spacer, let your child breathe normally and wait necessary time between puffs (usually one minute).
8. For next puff, repeat steps 3 to 7.
Children quickly adapt to taking the medication in this way. Some parents find it helpful for their child to be in a highchair or sitting in another chair. Pretending to be a fireperson with a mask or an astronaut is often helpful.
Frequently check MDI for fullness and spacer valve leaflets for any sign of curling.
A) If your child uses the inhaler daily, you can multiply the number of puffs used in one day times seven days and have a general idea of how many puffs have been used in a week. The MDI canister is labeled with the number of inhalations it contains. Use this number as a guideline. Not on your calendar one to two weeks in advance of the time you will need a refill of this medication. Discard the canister after you have used the labeled number of inhalations. The correct amount of medication in each inhalation cannot be guaranteed after this point.
B) If your child uses their inhaler sporadically, shake the canister to feel if there is a fluid still present inside, or you may depress the canister to actually see that medication is being dispensed.
C) Note the expiration date of the canister and do not use after that date.
D) Replace spacer when inside valve leaflets begin to curl.
Cleaning Spacer:
Spacer should be cleaned on a regular basis following manufacturer's instructions.
Breath Activated Device (Diskus, Turbuhaler, Twisthaler, Aerolizer, Rotahaler):
1. Stand upright and tall
2. Breathe out (exhale) fully without the inhaler in your mouth. Do NOT exhale into the mouthpiece of the medication.
3. Place medicine mouthpiece into your mouth, holding it in a horizontal position. Firmly close your lips around the mouthpiece.
4. Breathe in quickly and deeply. Most medications are a very fine powder so you may not be able to feel or taste it after inhalation.
5. Hold your breath for 10 seconds (slow count to 10) or as long as you can, then breathe out... BUT...DO NOT breathe out through the inhaler.
6. Wipe the mouthpiece dry, if necessary, and immediately replace the cap. Dispensers must be closed fully to prime for next inhalation. Prime (twist) to get ready for the next inhale if necessary and repeat steps 1-5.
* Most breath-activated dispensers are corticosteroids. It is VERY important to fully rinse your mouth and brush your teeth (if possible) after inhalation.
Nebulizer:
With mask (younger children)
With mouthpiece (older children)
A nebulizer is a simple air compressor that turns liquid medication into a mist that can then be easily breathed into the lungs. Nebulizer treatments are the usual method to give infants and toddlers medication because they are too young for a MDI. Sometimes during an asthma exacerbation, older children will also take medication via nebulizer treatments since this is such an efficient mode of delivery.
How To Give A Nebulizer Treatment:
1. Plug nebulizer in.
2. Attach clear tubing to nebulizer.
3. Put prescribed amount of each medication into medicine cup.
4. Attach mask or mouthpiece to medicine cup.
5. Attach medicine cup with mask or mouthpiece to clear tubing.
6. With your child in a comfortable position, place mask on your child's face or your child places mouthpiece in his mouth.
7. Turn machine on. If using a mask, the infant breathes normally. A child using a mouthpiece should take slow, deep breaths. With a mouthpiece, your child may have a large amount of saliva. Your child may need to remove the mouthpiece periodically during the treatment and swallow their saliva.
Length of treatment averages five to ten minutes. When no more mist is visible, the treatment is finished. You will also hear the difference when there is no further medication in medicine cup. If treatments begin to take longer than usual, your nebulizer kit may need to be replaced. If this does not resolve the problem, contact the company from which you purchased your nebulizer.
Some infants or toddler are frightened of the mask when first starting nebulizer treatments. It is helpful if the parents develop a routine for the treatments. Read a book, rock and sing to the infant, watch a tape with a child for the treatment time. Quickly the treatments become routine and the child adapts to them. While difficult to believe, if an infant or child cries during the treatment with the mask, the child still receives the medication to their lungs.
If your infant or child totally fights the mask, treatment can be given by "blow by" method. Blow by method is a mouthpiece kit with some modifications. Remove the mouthpiece and cover the back portion of the remaining "T" piece with a piece of tape. This will then offer only one stream of mist. Hold the mist stream close to your child's face and allow them to breathe this way. A mask or mouthpiece is preferable, but blow by method can be used.
Clean the nebulizer kit regularly and follow the manufacturer's instructions.
It is good judgment to keep a new nebulizer kit as a spare at all times. Generally, kits last several months.
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