Metered Dose Inhaler with Spacer

Inhaled medicines are the basis of treatment of asthma and other breathing problems. Inhaled medicine can only be effective if used properly. Good technique assures that the medicine reaches the lungs. Your caregiver has asked you to use a spacer with your inhaler. A spacer is a plastic tube with a mouthpiece on one end and an opening that connects to the inhaler on the other end. A spacer helps you take the medicine better.

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

If you are using different kinds of inhalers, use your quick relief medicine to open the airways 10 to 15 minutes before using a steroid. If you are unsure which inhalers to use and the order of using them, ask your caregiver, nurse, or respiratory therapist.


  1. ExitCare ImageRemove cap from inhaler.

  2. Shake inhaler for 5 seconds before each inhalation (breathing in).

  3. Place the open end of the spacer onto the mouthpiece of the inhaler.

  4. Position the inhaler so that the top of the canister faces up and the spacer mouthpiece faces you.

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

  6. Exhale (breathe out) normally and as completely as possible.

  7. Immediately after exhaling, place the spacer between your teeth and into your mouth. Close your mouth tightly around the spacer.

  8. Press the canister down with the index finger to release the medication.

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

  10. Hold the medication in your lungs for up to 10 seconds (10 seconds is best). This helps the medicine get into the small airways of your lungs to work better. Exhale.

  11. Repeat inhaling deeply through the spacer mouthpiece. Again hold that breath for up to 10 seconds (10 seconds is best). Exhale slowly. If it is difficult to take this second deep breath through the spacer, breathe normally several times through the spacer. Remove the spacer from your mouth.

  12. Wait at least 1 minute between puffs. Continue with the above steps until you have taken the number of puffs your caregiver has ordered.

  13. Remove spacer from the inhaler and place cap on inhaler.

If you are using a steroid inhaler, rinse your mouth with water after your last puff and then 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.


  • Determine when an inhaler is empty. You cannot know when an inhaler is empty by shaking it. A few inhalers are now being made with dose counters. Ask your caregiver for a prescription that has a dose counter if you feel you need that extra help.

  • If your inhaler does not have a counter, check the number of doses in the inhaler before you use it. The canister or box will list the number of doses in the canister. Divide the total number of doses in the canister by the number you will use each day to find how many days the canister will last. (For example, if your canister has 200 doses and you take 2 puffs, 4 times each day, which is 8 puffs a day. Dividing 200 by 8 equals 25. The canister should last 25 days.) Using a calendar, count forward that many days to see when your inhaler will run out. Write the refill date on a calendar or your canister.

  • Remember, if you need to take extra doses, the inhaler will empty sooner than you figured. Be sure you have a refill before your canister runs out. Refill your inhaler 7 to 10 days before it runs out.


  • Do not use the inhaler more than your caregiver tells you. If you are still wheezing and are feeling tightness in your chest, call your caregiver.

  • Keep an adequate supply of medication. This includes making sure the medicine is not expired, and you have a spare inhaler.

  • Follow your caregiver or inhaler insert directions for cleaning the inhaler and spacer.


  • Symptoms are only partially relieved with your inhaler.

  • You are having trouble using your inhaler.

  • You experience some increase in phlegm.

  • You develop a fever of 102° F (38.9° C).


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

  • If you have side effects such as dizziness, headaches or fast heart rate.

  • You have chills, fever, night sweats or an oral temperature above 102° F (38.9° C).

  • Phlegm production increases a lot, or there is blood in the phlegm.


  • Understand these instructions.

  • Will watch your condition.

  • Will get help right away if you are not doing well or get worse.