MDI, DPI, and nebulizer use; common errors; spacers; and multi-inhaler sequencing
Inhaled medications are the cornerstone of COPD and asthma management — but only if they actually reach the lungs. Studies show that more than 80% of patients make at least one critical error in inhaler technique, and clinicians are only slightly better. Mastering inhaler technique — and teaching it effectively — is one of the highest-impact interventions in respiratory home care.
MDIs deliver a precise measured dose of medication when actuated. Without a spacer, coordination of actuation and inhalation is required — a skill many clients (and clinicians) do not achieve reliably.
1. Shake the inhaler for 5 seconds. 2. Attach to spacer. 3. Exhale completely to empty the lungs. 4. Place spacer mouthpiece in mouth, seal lips. 5. Actuate one puff into the spacer. 6. Inhale slowly and deeply over 4–5 seconds. 7. Remove spacer, hold breath for 10 seconds. 8. Exhale slowly. 9. If a second puff is needed, wait 15–30 seconds and repeat from step 1.
Spacers (valved holding chambers) double pulmonary drug deposition by allowing time for propellant to evaporate and eliminating the need for perfect hand-breath coordination. All clients using MDIs should use a spacer.
DPIs (Advair Diskus, Spiriva HandiHaler, Ellipta devices) deliver powder medication that is drawn into the lungs by the force of inhalation. Key differences from MDI: no shaking required, no spacer needed, and most critically — inhalation must be fast and forceful, not slow and steady. A slow inhalation leaves the powder in the device.
Load the dose per device-specific instructions. Exhale completely (away from the device — moisture deactivates the dose). Seal lips around the mouthpiece. Inhale fast and deep. Hold 10 seconds. Check the dose counter to confirm delivery.
Nebulizers convert liquid medication to a mist delivered through a mask or mouthpiece. Preferred for clients who cannot master inhaler technique, those with severe breathlessness, or children. Medication is placed in the medication cup, the client breathes normally through the mask for 10–15 minutes until the medication is gone (sputtering begins). Clean the nebulizer cup and mouthpiece after each use; sterilize per protocol. Contaminated nebulizer cups are a significant infection risk.
Top errors: not shaking the MDI, not exhaling before inhaling, actuating before inhaling (or after), inhaling too fast (MDI) or too slow (DPI), not holding breath after inhalation, and not rinsing mouth after inhaled corticosteroids (causes oral thrush). For clients on multiple inhalers: use the rescue bronchodilator first (opens airways), wait one minute, then use the maintenance inhaler. If a corticosteroid inhaler is in the regimen, it comes last. Rinse mouth after inhaled steroids without exception.
Complete this 5-question quiz with 80% or higher to earn your CEU credit for this lesson.