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Metered-Dose Inhaler Demonstration: Open and Closed-Mouth Techniques

This article will demonstrate how to use a metered-dose inhaler by using either the open or closed-mouth technique.

What is a metered-dose inhaler? It’s an inhaler used to administer a set amount of medication into the lungs. Medications that are used include bronchodilators, corticosteroids etc.

When administering a MDI, it is important to teach the patient proper technique. This will help increase the amount of medication that enters the lungs rather than the mouth.

Important Facts about MDIs:

metered dose inhaler, broncodilator, corticosteroids, inhaler, nclexTypes of MDIs:

  • Bronchodilators: Albuterol (also called Ventolin HFA or ProAir HFA)
  • Corticosteroids: Fluticasone (also called Flovent HFA)
  • Also, a single inhaler can be used which contains a combination of drugs like Symbicort (this contains both a bronchodilator and corticosteroid).

It is best to use a spacer when using a metered-dose inhaler. This will ensure most of the medication enters the lungs rather than the mouth. Corticosteroids can be very irritating to the mouth and can cause thrush.

If a spacer is not used, the open-mouth or closed-mouth technique can be used. Always teach the patient to use the method prescribed by the physician.

The method used by the patient depends on the patient’s ability to hold the inhaler and follow directions. For example, the open-mouth technique may be hard for younger or older patients to perform, and they should be taught to use a spacer or the closed-mouth technique.

***The key with both techniques is to breath in and spray the inhaler at the same time…if done at different times this will affect the amount of medication that will be administered into the lungs and may lead to most of the medication staying in the mouth. 

Open-mouth Technique for Metered-dose Inhaler

  1. Perform hand hygiene
  2. Perform the patient’s 5 rights (right patient, right time, right route, right drug, right dose)
  • How many puffs are being administered? If 2 or more…give one puff and wait 1 minute before the next one.
  • Look at the inhalers ordered: are you giving both a bronchodilator and corticosteroid inhaler?
    • Which one will you administer first? The BRONCHODILATOR and then the corticosteroid.
      • WHY? The bronchodilator will open the airways to allow the corticosteroid to work. *Wait 5 minutes in between the bronchodilator and corticosteroid
      • Confirm there are enough doses in the inhaler:
        • To do this, look at the inhaler’s counter (found on the inhaler) or look at how many sprays are in each inhaler (found on the box).
  1. Prime the inhaler:
  • When do you prime the inhaler?
    • First time using, haven’t used in 1 or more weeks, dropped it, or recently cleaned it
      • Note: Every inhaler is different in how many spray are needed to prime the inhaler, so always read the instructions.

1.Remove the cap.

2. Shake it up and down for 8 to 10 seconds.

3. Spray it in the air per the inhaler’s manual instructions. Be sure to keep it away from yourself and other people.

priming metered dose inhaler, mdi, demonstration

4. Have the patient sit-up.

5. Hold the inhaler in between the thumb and two fingers.

metered dose inhaler demonstration, nursing, nclex, how to use6. Shake the inhaler for 8-10 seconds.

7. Measure two fingers in between mouth and inhaler and aim the inhaler at the mouth.

metered dose inhaler open mouth technique, how to use, demonstration, nursing8. Breathe in and breathe out all the way through the mouth (not nose) until can no longer.

9. AT THE SAME TIME…breathe IN slowly through the mouth and press down on the inhaler…keep breathing in until no longer able.

metered dose inhaler, nclex, nursing

10. Hold breath for 10-12 seconds and then breathe out slowly.

***Always gargle and rinse mouth with water and SPIT after using a corticosteroid inhaler.

*If more than 1 puff is ordered, repeat in one minute.

11. Then recap inhaler.

12. Perform hand hygiene and document.

Closed-mouth Technique for Metered-dose Inhaler

  1. Perform hand hygiene
  2. Perform the patient’s 5 rights (right patient, right time, right route, right drug, right dose)
  • How many puffs are being administered? If 2 or more…give one puff and wait 1 minute before the next one.
  • Look at the inhalers ordered: are you giving both a bronchodilator and corticosteroid?
    • Which one will you administer first? The BRONCHODILATOR and then the corticosteroid.
      • WHY? The bronchodilator will open the airways to allow the corticosteroid to work. *Wait 5 minutes in between the bronchodilator and corticosteroid
      • Confirm there are enough doses in the inhaler:
        • To do this, look at the inhaler’s counter (found on the inhaler) or look at how many sprays are in each inhaler (found on the box).
  1. Prime the inhaler:
  • When do you prime the inhaler?
    • First time using, haven’t used in 1 or more weeks, dropped it, or recently cleaned it
      • Note: Every inhaler is different in how many spray are needed to prime the inhaler, so always read the instructions.

1. Remove the cap.

2. Shake it up and down for 8 to 10 seconds.

3. Spray it in the air per the inhaler’s manual instructions. Be sure to keep it away from yourself and other people.

4. Have the patient sit-up.

5. Hold the inhaler in between the thumb and two fingers.

metered dose inhaler demonstration, nursing, nclex, how to use6. Shake inhaler for 8-10 seconds.

7. Breathe in and breathe out all the way through the mouth (not nose) until can no longer.

8. Place mouthpiece in mouth in between teeth (keep tongue flat) and seal mouth around the inhaler.

metered dose inhaler closed method technique, nursing, demonstration, how to use9. AT THE SAME TIME…breathe IN slowly through the mouth and press down on the inhaler…keep breathing in until no longer able.

10. Hold breath for 10-12 seconds and then breathe out slowly

***Always gargle and rinse mouth with water and SPIT after using a corticosteroid inhaler.

*If more than 1 puff is ordered, repeat in one minute.

11. Then recap inhaler

12. Perform hand hygiene and document.

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