Metered Dose Inhaler

Instructions for Children, 6 Years and Older with a Mouthpiece Spacer: 1. Remove (dust) cap. 2. Place inhaler into rear of spacer. 3. Shake vigorously (this can be done now or before inhaler is placed into spacer). 4. Breathe out fully, but not forcefully. 5. Activate inhaler (push down to spray medication). 6. Immediately place into mouth with lips snug around mouthpiece. 7. Take a slow deep breath in (most spacers make noise if you inhale too fast). 8. Hold your breath (count to 10). 9. Breathe out slowly. 10. If giving more than one puff, repeat steps 3-9.

Instructions for Children Younger than 6 Years with Mask Spacer: Many children younger than 6 years of age use a mouthpiece when their asthma is under control. However, it is important to use a device that will work even when their asthma is not under control (for example, the child cannot hold his/her breath, the child is tired, can’t breathe or rushes to take a breath in, even with the spacer), in that case, a mask is a better choice. 1. Remove (dust) cap. 2. Place inhaler into rear of spacer. 3. Shake vigorously (this can be done now or before inhaler is placed into spacer). 4. Place spacer with mask over face, covering mouth and nose, creating a good seal. 5. Activate inhaler (push down to spray medication). 6. Watch for 6 good breaths (you can see through the clear plastic and see the rubber leaflets move with each breath) or if able, 1 or 2 slow deep breaths, holding breath (count to 10). Remove mask from face. 7. If giving more than one puff, repeat steps 3-6.

Medicine Information:  Cromolyn sodium and the inhaled steroids do not have an immediate effect and may take 2-4 weeks to be fully effective. Cromolyn sodium may have an immediate effect when used before exercise.  When using an inhaled steroid, rinse, gargle and spit and/or brush teeth after each treatment. If the child is too young to follow directions, have the child drink some water. This will help avoid an infection in the mouth.  When giving multiple medicines, give the “reliever” (Albuterol®) first and the steroid last. Follow your doctor’s instructions for all medicines. Care of the Metered Dose Inhaler and Spacer

Daily Cleaning of the Inhaler and the Spacer If the inhaler is not cleaned well, the valve may become clogged. This may prevent your child from receiving the amount of medicine prescribed. Follow these steps to keep the inhaler clean: 1. Remove the (dust) cap and the metal canister from the plastic body. 2. Remove the (dust) cap and the rubber end cap from the spacer. 3. Rinse, both plastic dust caps, rubber seal, plastic inhaler body and the spacer thoroughly under warm, running water. Shake off excess water. 4. Air-dry thoroughly or dry with a clean cloth and reassemble.

Miller Children’s Hospital Long Beach: Patient/Family Education Committee Revised: 12/2008 (MCHLB/mb) Replacing the Metered-Dose Inhaler Running out of medicine may delay the treatment your child needs to prevent or treat an asthma attack. Ask your doctor or pharmacist how long the canister should last when used as prescribed. Learn how to tell when the metal canister is becoming empty:  Do not use “floating in water technique” to check how full your inhaler canister is.  Mandatory refills are required.  Ask your doctor:  When the prescription says 1 or more refills.  Should the medication be stopped when last refill is used up?  Should you call for more refills before it is used up?

Use and Care of a Nebulizer  A nebulizer is a device driven by a compressed air machine that helps deliver medicine to the lungs. It allows you to take asthma medicine in the form of a mist (wet aerosol).  It consists of a cup, a mouthpiece attached to a T-shaped tube or a mask and long, thin plastic tubing to connect the nebulizer to the compressed air machine. Three types of patients use it: young children under age 5, patients who have problems using metered dose inhalers or patients with severe asthma.  A routine for cleaning the nebulizer is important because an unclean nebulizer may cause infection.  A good cleaning routine keeps the nebulizer from clogging up and helps it last longer.  Directions for using the compressed air machine may vary (check and follow the machine's directions).

Miller Children’s Hospital Long Beach: Patient/Family Education Committee Revised: 12/2008 (MCHLB/mb)