Metered Dose Inhalers

Medication Information Leaflet

What are Metered Dose Inhalers (MDIs)?

  • Metered Dose Inhalers (MDIs) are inhaler devices that help deliver a fixed amount of medication to your lungs.
  • They are used to deliver medications that are used for the treatment of asthma and chronic obstructive pulmonary disease (COPD).

Why is it important to use MDIs correctly?

  • It is important to use MDIs correctly in order to get the full dosage and benefits of the medication.
  • This allows the medication to have a higher chance of reaching the small airways, which increases the effectiveness of the medication and reduces side effects.

How do MDIs work?

  • Each MDI consists of a pressurized canister of medication and a mouthpiece.
  • Pressing down the canister releases a mist of medication that you breathe into your lungs.
  • It can also be used together with a spacer and/or a mask to help you breathe in your medication better.

How should I take/use MDIs?

​Steps 
​Description
​1
​​Remove the cap from the inhaler.
​2
​​Shake the inhaler for 3 to 5 seconds.
​3
​​If you are using a new inhaler or have not used the inhaler for several days, prepare the device by releasing two puffs of medicine into the air. 
​4
​​Breathe out gently, away from the inhaler.
​5
​Hold the inhaler upright. Place the mouthpiece in your mouth and seal tightly with your lips. Do not bite the mouthpiece.
​6
​Start to breathe in slowly and steadily and at the same time. 
​7
​​Press the canister on the inhaler once to release a dose while continuing to breathe in slowly and deeply through your mouth. 
​8
​​Remove the inhaler and hold your breath for about 10 seconds or as long as you can.
​9
​Breathe out gently away from the inhaler.
​10
​If you need to take another puff, wait for 1 minute before repeating steps 4 to 8.
​11
​​​Clean the mouthpiece with dry tissue and replace the cap.
​12
If you need to use more than one type of inhaler, use the reliever (salbutamol) inhaler first. Wait for at least five minutes before using the next inhaler. 

What should I avoid when using MDIs?

  • Holding the inhaler upside down
  • Pressing the inhaler more than once at a time
  • Pressing the inhaler too early or too late
  • Opening your mouth when the jet of the inhaled medication hits the back of your throat.
  • Not inhaling deeply and long enough
  • Not holding your breath long enough
The last 4 problems can be solved by using a spacer. Consult your healthcare professional if you encounter any of these problems.

How should I use a spacer together with the MDIs?

​Steps 
​Description 
​1
​Remove the cap from the inhaler.
​2
​Shake the inhaler for 3 to 5 seconds
​3
​If you are using the MDI for the first time or if MDI has not been used for several days, release 2 puffs into the air to prepare it. 
​4
​Hold the inhaler upright and attach it to the end of the spacer.
​5
​If you are using the spacer for the very first time, prepare it by pressing the inhaler 10 times.
​6
​If a mask is used: Attach the mask to the spacer. Place the mask securely over your mouth and nose. Ensure that it fits tightly with no gap between the mask and your face. 

If no mask is used: Place the spacer mouthpiece in your mouth and seal tightly with your lips.
​7
​Press the canister of the inhaler down once to release one puff of medication into the spacer.
​8
​Breathe in and out normally through the spacer for 5 to 10 breaths. Check the technique via the movement of the breathing valve opening and closing for 5 to 6 times. 
​9
​Alternatively, take a deep breath and hold for about 10 seconds or as long as you can. Then breathe out normally. You do not need to take the spacer out of your mouth to exhale. 
​10
​If you need to take extra doses, wait for a minute before repeating steps 6 to 8 for each puff. Only one puff should be released into the spacer each time. 
​11
​If you use more than one type of inhaler through the spacer, use the reliever (Salbutamol) inhaler first, wait for at least 1 to 2 minutes before using the next inhaler. 
​12
​Remove the spacer from mouth or mask from your face. Wipe clean the mouthpiece of the spacer or facemask. 
​13
​Remove the inhaler from the spacer and replace the mouthpiece cap. 
Additional counselling points:
a)      If both controller and reliever are to be used at the same time, you should always use the reliever first followed by the controller, wait for about 1 minute in-between the inhalers.
b)      Please remember to gargle and rinse your mouth with water after using a steroid-containing controller.

How should I store my MDIs?

Store in a cool and dry place, away from direct sunlight. Keep this medication away from children.
     
MDIs may or may not include the dose counters to let you know the number of doses left in the MDI. 
  • For MDI with dose counters, throw away the MDI once the dose counter reaches zero.
  • For MDI without dose counters, record the number of doses you use each time. Throw away the MDI once you have used the number of doses stated on the product.

How should I clean my MDIs?

​Steps 
​Description 
​1
​Only wash MDIs without dose counters. Do not wash MDIs with dose counters.
​2
​Remove the metal canister from the external canister holder. 
​3
​Soak the external canister holder in warm soapy water for about 30 seconds. Alternatively, wash the external holder of the canister under running water. 
​4
​Shake off excess water and allow the case to air-dry overnight.
​5
​Put back the metal canister into the dry plastic case the next day.
​6
​Test the inhaler by releasing a puff of medication into the air.
​7
​You can wash your MDIs once a week.

How should I clean my spacer?

​Steps
​Description
​1
​Dismantle the spacer (if necessary).
​2
​Soak the spacer in lukewarm water with few drops of liquid detergent for about 15 minutes. The depth of water should be enough to submerge the spacer with or without the facemask. 

Do not scrub the spacer or place the breathing valve of the spacer directly under running water. 

Do NOT rub dry with a cloth as this will increase the amount of static in the plastic container and may affect the amount of medication that you receive.

Do NOT rinse your spacer as the detergent reduces the static charges as well.
​3
​Shake off the excess water and leave the spacer to air dry. 
​4
​You can wash your spacer once a month. 

You may wish to follow the package insert on how to clean your spacer and when to replace your spacer as instructions may be different for each device.


How should I throw away the MDI safely?

Pack the spacer into a black trash bag and seal it tightly before throwing into the rubbish chute or bin.


Disclaimers
If you take more than the recommended dose, please seek medical advice immediately. The information provided on this page does not replace information from your healthcare professional. Please consult your healthcare professional for more information.

This article is jointly developed by members of the National Medication Information workgroup. The workgroup consists of cluster partners (National Healthcare Group, National University Health System and SingHealth), community pharmacies (Guardian, Unity and Watsons) and Pharmaceutical Society of Singapore. The content does not reflect drug availability and supply information in pharmacies and healthcare institutions. You are advised to check with the respective institutions for such information.

Last reviewed on October 2020
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