Metered Dose Inhalers (MDIs): How to Use One When You Have COPD

People who have chronic obstructive pulmonary disease (COPD) or other lung conditions often take their medications using devices called a hydrofluoroalkane inhaler or HFA (former called a metered dose inhaler or MDI) or a dry powder inhaler (DPI).

What is a hydrofluoroalkane inhaler?

A hydrofluoroalkane inhaler is a handheld device that delivers a specific amount of medication in aerosol form, rather than as a pill or capsule. The HFA consists of a pressurized canister inside a plastic case, with a mouthpiece attached. With an HFA, you press on the device while inhaling the COPD medication directly into your lungs. Its portability makes it easy to use anywhere,anytime. HFAs use a chemical propellant to push medication out of the inhaler.

What is a dry powder inhaler?

Some medications can be taken in the form of a dry powder, using a dry powder inhaler, which is also a handheld device. A DPI delivers medication to the lungs as you inhale through it. It doesn't contain propellants or other ingredients -- just your medication.

Why is it important to learn how to use my inhaler?

If you use the hydrofluoroalkane inhaler or dry powder inhaler the right way, you receive the right amount of COPD medication and it can reach deep inside your lungs. Then you can gain the full benefit of the medication. Also, if you use your inhaler the right way, you are less likely to experience side effects.

How do I use a hydrofluoroalkane inhaler?

These are the general steps for using a hydrofluoroalkane inhaler for COPD:

  1. Remove the cap from the hydrofluoroalkane inhaler.
  2. Shake the inhaler for a few seconds.
  3. Place your index finger on top of the canister and thumb on the bottom of the mouthpiece.
  4. Tilt your head back slightly and breathe out.
  5. Hold the inhaler upright about the width of two fingers from your mouth.
  6. Press down on the inhaler once as you breathe in as slowly and deeply as you can - about 3 to 5 seconds.
  7. If possible, hold your breath for at least 10 seconds.
  8. If your doctor prescribed more than one puff of COPD medication, wait about 1 minute and repeat steps 2-8.
  9. Replace the cap on the metered dose inhaler.
  10. Gargle and rinse your mouth with water or mouthwash (usually advised only for steroid-type inhalers).

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How do I keep track of how much medication is in my hydrofluoroalkane inhaler?

Check the side of the canister for the number of puffs it contains. Then keep track of how many times you use it each day. This way, you can estimate when your HFA is likely to run out. Put that date right on the canister. Be sure to have your prescription refilled one to two days before this date. Some HFAs contain a color-coded side window that indicates when the medication is running out.

It may be difficult for you to keep track of how much you use your inhaler -- perhaps because you only use it every once in a while as a rescue medication. If so, ask your doctor about HFAs that count the puffs each time you press the inhaler. Or ask about getting two inhalers at a time. When one runs out, get a refill so you always have an inhaler handy.

Throw away the HFA when it is empty, even if it continues to spray.

How do I use a dry powder inhaler?

These are the general steps for using a dry powder inhaler for COPD:

  1. Remove the cap from the dry powder inhaler.
  2. Load a dose of medicine (how you do this depends on the type of inhaler you have).
  3. Turn your head and breathe out as much air as you can -- try and empty your lungs.
  4. Put the dry powder inhaler up to your mouth.
  5. Place the mouth-piece in your mouth and seal your lips firmly around the opening so no air or medicine can escape out the sides.
  6. Using just your mouth, breathe in once -- very deep and fast -- filling your lungs as deeply as you can. Dry powder inhalers are breathe-activated, so it's the breathing in deep and fast that gives you the right dose of medicine. Never breathe into the inhaler.
  7. Take your mouth off the inhaler and hold your breath for at least 10 seconds. Then slowly breathe out.
  8. If your doctor prescribed more than one dose of COPD medication, wait about 1 minute before taking the next dose.
  9. Replace the cap on the dry powder inhaler. Gargle and rinse your mouth with water or mouthwash (usually advised only for steroid-type inhalers).

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How do I keep track of how much medication is in my dry powder inhaler?

Your DPI should have an indicator on the top or sides, telling you how many doses you have left. Make sure you have a new dry powder inhaler available before the old one is empty.

What is a spacer?

A spacer is a tube that attaches to a metered dose inhaler (you don't need a spacer with a dry powder inhaler). It holds the medication until you can breathe it in. The spacer ensures that anyone who does not use the device correctly gets the COPD medicine from the HFA to their lungs. For this reason, it also lessens side effects.

Spacers are sometimes needed because some people find it difficult to use a metered dose inhaler the right way. If you have trouble coordinating your breathing with pressing on the inhaler, ask your doctor about using a spacer.

How do I use a metered dose inhaler with a spacer?

These are the general steps for using a spacer. Be sure to read the instructions that come with yours. They may be slightly different.

  1. Remove the caps from the hydrofluoroalkane inhaler and spacer.
  2. Insert the inhaler into the open end of the spacer.
  3. Shake the inhaler for a few seconds.
  4. Breathe out completely.
  5. Place the mouthpiece of the spacer between your teeth. Seal your lips tightly around it.
  6. Press the canister once to dispense the medication into the spacer.
  7. Breathe in slowly through your mouth for about 3 to 5 seconds. If you hear a hornlike sound, slow down. This means you are breathing too quickly.
  8. Hold your breath for at least 10 seconds.
  9. If your doctor prescribed more than one puff of COPD medication, wait about 1 minute and repeat steps 3-8.
  10. Remove the spacer from the inhaler and replace the caps on the inhaler and spacer.
  11. Gargle and rinse your mouth with water or mouthwash.

How do I care for my inhalers and spacer?

Here are some basic guidelines for caring for metered dose inhalers and dry powder inhalers, but be sure to follow any additional instructions your healthcare provider gives you.

  • Use a dry cloth to wipe away powder or residue from your inhaler. Only use water if your health care provider recommends it.
  • Clean a spacer every other day - or once a week if you use it rarely. Remove the soft ring at the end of the spacer. Soak the spacer and ring in warm water with mild detergent. Rinse the ring and spacer in warm water. Let the ring and spacer air dry.
  • Do not store your hydrofluoroalkane inhaler or dry powder inhaler near heat or an open flame.
WebMD Medical Reference Reviewed by Dan Brennan, MD on July 19, 2019

Sources

SOURCES: National Jewish Medical and Research Center: "Inhaled Medication With a Metered Dose Inhaler (MDI)" and "Inhaled Medication With a Metered Dose Inhaler (MDI) and Spacer." MedlinePlus: "Encyclopedia: Metered dose inhaler use." WebMD Medical Reference provided in collaboration with The Cleveland Clinic: "Asthma Guide: Using Your Metered Dose Inhalers and Spacers." American Academy of Family Physicians: "Metered-Dose Inhaler: How to Use It Correctly." National Lung Health Education Program" "Devices." WebMD Medical Reference provided in collaboration with the Cleveland Clinic: "Dry Powder Inhalers." Healthtouch Online: "How to Use a Dry Powder Inhaler."

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