Inhaled Therapy

Medications via the inhalation route: Breathing through an inhaler to direct a medication into the lungs

PSW Considerations:

  • Ensure that the PSW understands the following:
    • There are different types of inhalers:
      • Metered Dose Inhaler (MDI) – sometimes used with a spacer chamber
      • Single dose or multi-dose Dry Powder Inhaler (DPI)
    • Only use the inhaler you received training for
  • Report to the office at 416-635-2860 if:
    • Medication has run out
    • Lost or damaged inhaler
    • Defective inhaler (not working properly)
    • Client is showing signs of increased shortness of breath or increased coughing after inhaling the medication

What is Priming?

  • Priming is spraying one or more puffs (doses) of the medication into the air before use. This is done to ensure the inhaler fills with the right amount of medication in the dosing chamber so it is ready for use. You should assist the client with priming their inhaler if it is the first time you use a new inhaler and again if the client has not used the inhaler for several days or weeks.
  • To prime the inhaler:
    1. Remove the cap of the MDI.
    2. Shake the inhaler.
    3. Spray one or two puffs into the air away from you.

Required supplies:

  • Inhaler with the medication
  • Water for the client to rinse their mouth
  • Gloves

Metered Dose Inhaler (MDI)

  • Used to provide the client with a measured dose of a medication when the canister is pushed down.
  • The inhaler should be cleaned after each use to prevent buildup that will clog the inhaler.

Steps to assist the client with a MDI:

  1. Perform hand hygiene and put on gloves.
  2. Remove the cap from the mouthpiece of the inhaler. Hold the inhaler upright and shake vigorously 5 or 6 times.
  3. Allow the client to hold the inhaler in an upright position with their index finger on the top and thumb on the bottom.
    • Assist the client by holding their hand steady.
    • If the client cannot hold or press the inhaler, you may do this step.
  4. Position the mouthpiece 1½ – 2 inches (2 – 4 cm) away from the client’s mouth.
  5. Instruct the client to:
    • Tilt their head back slightly.
    • Open their mouth wide and take a deep breath in, followed by a slow breath out through their mouth.
    • Press down on the inhaler to release the medication and breathe in through their mouth, slowly and deeply.
  6. Repeat steps #3-5 until the client has inhaled the prescribed number of puffs. Allow the client to rest for 1 minute in between puffs.
  7. Give the client water to rinse their mouth thoroughly and ensure the client spits out the water and does not swallow it.
  8. Clean the inhaler.
  9. Remove gloves and perform hand hygiene.

Cleaning a Metered Dose Inhaler:

  1. Clean the inhaler and the cap by rinsing them in warm running water. Let them dry before you use it again.
  2. Wash the plastic mouthpiece with mild dishwashing soap and warm water. Rinse and dry it well before putting it back.
  3. If a spacer was used, wash it with mild dishwashing soap and water. Rinse and dry it well before the next use.

Spacer (holding chamber)

  • Attaches to the inhaler and holds the medication in its chamber to facilitate inhalation in one or two slow breaths.

Steps to assist the client with a spacer:

  1. Perform hand hygiene and put on gloves.
  2. Attach the spacer or holding chamber to the inhaler.
  3. Shake the inhaler vigorously 5 or 6 times.
  4. Press down on the top of the inhaler canister to release one dose of medication into the chamber.
  5. Place or allow the client to place the mouthpiece of the spacer into their mouth.
  6. Instruct the client to inhale slowly, hold their breath for a few seconds, and then exhale.
  7. Repeat these steps until the client has inhaled the prescribed number of puffs. Allow at least 1 minute in between puffs.
  8. Give the client water to rinse their mouth thoroughly. Make sure the client spits out the water and does not swallow it.
  9. Clean the spacer after each use.
  10. Remove gloves and perform hand hygiene.

Single-Dose: Dry Powder Inhaler (DPI)

  • Inhalers that contain a dry, powdered medication that the client inhales.Steps to assist the client with a DPI:
  1. Perform hand hygiene and put on gloves.
  2. Remove the cap on the inhaler or slide the cover to open the inhaler.
  3. Load a dose of the medication in the inhaler before each use.
    • Powdered medicine is in the form of a capsule.
    • Each capsule is one-time use only.
    • A new capsule must be loaded into the inhaler before each use.
    • The PSW can load a capsule into the inhaler only if instructed by the CSS.
  4. Instruct the client to tilt their head upward, take a deep breath in and then breathe out slowly and completely.
  5. Hold the inhaler away from the client’s mouth while the client breathes out.
    • Do not let the client breathe out into the inhaler as this can blow some of the powdered medication out.
    • Moisture from the client’s breath can cause the dry powder to clump together and clog the inhaler.
  6. Assist the client with placing the inhaler’s mouthpiece into their mouth.
  7. The client should close their lips tightly around the mouthpiece.
  8. Instruct the client to:
    • Inhale quickly and deeply for 2-3 seconds through the mouth and remove the inhaler.
    • Hold their breath immediately after inhaling for 10 seconds (if possible).
    • Breathe out slowly through their nose.
  9. Remove the used medication capsule from the inhaler and discard it in the garbage.
  10. Repeat steps #3-8 if another dose is needed. Allow the client to rest for 1 minute in between puffs.
  11. Give the client water to rinse their mouth thoroughly and ensure the client spits out the water and does not swallow it.
  12. Clean the inhaler after each use with a clean, dry cloth.
  13. Remove gloves and perform hygiene.

Turbohaler

  • Inhalers that contain a dry powered medication that becomes activated when the client inhales.

Steps to assist the client with a Turbohaler:

  1. Perform hand hygiene and put on gloves.
  2. Slide the sleeve away from the mouthpiece.
  3. Turn the mouthpiece counter-clockwise to open it.
  4. Place the colored part of the medication into the stem of the mouthpiece.
  5. Rescrew the inhaler.
  6. Slide the sleeve all the way down to puncture the capsule.
  7. Instruct the client to fully exhale and then to deeply inhale and hold their breath for several seconds.
  8. Repeat steps # 4-7 if another dose is needed. Allow the client to rest for 1 minute in between puffs.
  9. Give the client water to rinse their mouth thoroughly and ensure the client spits out the water and does not swallow it.
  10. Clean the inhaler.
  11. Remove gloves and perform hygiene.

Video Resource

Please click on the video link below for a visual demonstration of the procedure:

References:

Asthma Initiative of Michigan. (2023). How to use a metered-dose inhaler the right way.
https://getasthmahelp.org/inhalers-how-to.aspx

Burke, A. (2023). Medication administration: NCLEX-RN.
https://www.registerednursing.org/nclex/medication-administration/#preparing-administering-medications-using-rights-medication-administration

Canada Lung Association (2017). Turbuhaler.
https://www.lung.ca/lung-health/get-help/how-use-your-inhaler/turbuhaler%C2%AE

Cleveland Clinic. (2020). Dry powder inhaler (DPI): Diskus.
https://my.clevelandclinic.org/health/drugs/6439-dry-powder-inhaler-dpi-diskus#:~:text=Place%20the%20Diskus%20mouthpiece%20in,Wipe%20off%20the%20mouthpiece

Cleaveland Clinic. (2023). Inhalers.
https://my.clevelandclinic.org/health/drugs/8694-inhalers

Healthwise. (2022). Using a dry powder inhaler: Care instructions.
https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=ud2113

Medical News Today. (2019). Nebulizers: What they are and how to use them.
https://www.medicalnewstoday.com/articles/324947#nebulizer-vs-inhaler

Mount Sinai. (2022). How yo us an inhaler – no spacer.
https://www.mountsinai.org/health-library/selfcare-instructions/how-to-use-an-inhaler-no-spacer

Potter, P., Perry, A. G., Stockert, P., Hall, A. (2019). Canadian fundamentals of
nursing (6th ed,. Astle, B. J., & Duggleby, W. Eds.). Elsevier Canada.
University of Manitoba Nursing Skills. (2018, November 2). Inhaled medication devices
[Video]. YouTube. https://youtu.be/pqvIEGUvIzI