Metered Dose Inhaler (No Spacer Used)

Inhaled medicines are the basis of asthma treatment and other breathing problems. Inhaled medicine can only be effective if used properly. Good technique assures that the medicine reaches the lungs.

Metered dose inhalers (MDIs) are used to deliver a variety of inhaled medicines. These include quick relief or rescue medicines (such as bronchodilators) and controller medicines (such as corticosteroids). The medicine is delivered by pushing down on a metal canister to release a set amount of spray.

ExitCare ImageIf you are using different kinds of inhalers, use your quick relief medicine to open the airways 10–15 minutes before using a steroid if instructed to do so by your health care provider. If you are unsure which inhalers to use and the order of using them, ask your health care provider, nurse, or respiratory therapist.


  1. Remove cap from inhaler.

  2. If you are using the inhaler for the first time, you will need to prime it. Shake the inhaler for 5 seconds and release four puffs into the air, away from your face. Ask your health care provider or pharmacist if you have questions about priming your inhaler.

  3. Shake inhaler for 5 seconds before each breath in (inhalation).

  4. Position the inhaler so that the top of the canister faces up.

  5. Put your index finger on the top of the medicine canister. Your thumb supports the bottom of the inhaler.

  6. Open your mouth.

  7. Either place the inhaler between your teeth and place your lips tightly around the mouthpiece, or hold the inhaler 1–2 inches away from your open mouth. If you are unsure of which technique to use, ask your health care provider.

  8. Breathe out (exhale) normally and as completely as possible.

  9. Press the canister down with the index finger to release the medicine.

  10. At the same time as the canister is pressed, inhale deeply and slowly until the lungs are completely filled. This should take 4–6 seconds. Keep your tongue down.

  11. Hold the medicine in your lungs for up to 5–10 seconds (10 seconds is best). This helps the medicine get into the small airways of your lungs.

  12. Breathe out slowly, through pursed lips. Whistling is an example of pursed lips.

  13. Wait at least 1 minute between puffs. Continue with the above steps until you have taken the number of puffs your health care provider has ordered. Do not use the inhaler more than your health care provider directs you to.

  14. Replace cap on inhaler.

  15. Follow the directions from your health care provider or the inhaler insert for cleaning the inhaler.

If you are using a steroid inhaler, rinse your mouth with water after your last puff, gargle, and spit out the water. Do not swallow the water.


  • Inhaling before or after starting the spray of medicine. It takes practice to coordinate your breathing with triggering the spray.

  • Inhaling through the nose (rather than the mouth) when triggering the spray.


You cannot know when an inhaler is empty by shaking it. A few inhalers are now being made with dose counters. Ask your health care provider for a prescription that has a dose counter if you feel you need that extra help. If your inhaler does not have a counter, ask your health care provider to help you determine the date you need to refill your inhaler. Write the refill date on a calendar or your inhaler canister. Refill your inhaler 7–10 days before it runs out. Be sure to keep an adequate supply of medicine. This includes making sure it is not expired, and you have a spare inhaler.


  • Symptoms are only partially relieved with your inhaler.

  • You are having trouble using your inhaler.

  • You experience some increase in phlegm.


  • You feel little or no relief with your inhalers. You are still wheezing and are feeling shortness of breath or tightness in your chest or both.

  • You have dizziness, headaches, or fast heart rate.

  • You have chills, fever, or night sweats.

  • There is a noticeable increase in phlegm production, or there is blood in the phlegm.