Instructions for using metered dose inhalers in children

The article was written by Nurses Nguyen Thi Mai and Duong Thi Hong - Pediatric Inpatient Department, Vinmec Times City International General Hospital.

A metered dose inhaler is a device that delivers a measured amount of medication into your lungs. You receive this medicine with each squeeze as you breathe in.

The metered dose inhaler uses a chemical propellant to create a jet stream (shot). This propellant carries a dosed dose of the drug into your lungs. The spray you see from a metered dose inhaler is both the propellant and the drug.

Spacers are particularly useful aids for the effective use of metered dose inhalers in young children or the elderly. The spacer is composed of a hollow chamber, one end is the place to attach the spray canister, the other end is the patient's mouthpiece. Just in front of the mouthpiece is a small valve, which opens only during inspiration, allowing air (containing medicine) to flow in only one direction from the spacer chamber into the patient's lungs. When the patient exhales, this valve closes, and air is released through the openings just in front of the valve without going back into the spacer chamber.

Step 1: Insert the metal potion into the plastic case, making sure it is in place. Step 2: Shake the sprayer several times to mix the propellant and medication. Step 3: Remove the cap from the mouthpiece. Step 4: Exhale slowly to the end of the normal exhalation. Step 5: Hold the sprayer in an upright position (the mouthpiece is at the bottom). Step 6: Place the mouthpiece in your mouth, past your teeth and above your tongue. Squeeze your lips tightly around the mouthpiece so the medicine doesn't get into your eyes. Step 7: While inhaling slowly and deeply through the mouth, press as much as possible once on the top of the metal canister of the inhaler. Step 8: Release the spray, purse your lips, and hold your breath for 5 to 10 seconds. Step 9: Exhale slowly. Step 10: If you use more than one puff, wait 15 to 30 seconds (or as directed in the box prescription) before taking the next puff. Then repeat steps 2 to 9. Step 11: Put the cap on the mouthpiece once done. Step 12: If you inhale steroid medicine, rinse your mouth with water immediately after each use and then spit it out to avoid sore throat and oral thrush.

Step 1: Make sure the metal canister of the sprayer is properly inserted into the plastic case. Step 2: Remove the cap from the mouthpiece of both the spray bottle and the spacer chamber. Step 3: Insert the mouthpiece of the spray into the soft hole of the spacer chamber. The metal canister of the sprayer must be in an upright position. Step 4: Shake the spray bottle with the spacer a few times to mix the drug and the propellant. Step 5: Exhale slowly to the end of a normal exhale. Step 6: Place the mouthpiece of the spacer in the mouth, past the teeth and above the tongue. Squeeze your lips tightly around the mouthpiece. If you use a masked spacer, place the mask over your nose and mouth. Make sure the mask is snug against your cheeks and chin. There should be no gaps between the mask and the skin. Step 7: Press the top of the metal potion once to release the drug into the spacer. Step 8: Inhale deeply and slowly through your mouth. If the spacer is buzzing, you're inhaling too quickly. You should avoid the whistle. Step 9: Stop breathing for 5 to 10 seconds. Step 10: Exhale slowly. Note that at this time, the mouth is still closed to the spacer. Step 11: For children who are too young to coordinate movements, after step 7 let the child take 10 breaths by observing the chest or watching the one-way valve of the spacer rise and fall 10 times. Step 12: If you are prescribed more than one puff, wait about 15 to 30 seconds (or as directed by the prescription in the box) before receiving a second puff. Then repeat steps 4 to 11. Step 13: Put the cap on the mouthpiece of the inhaler and the spacer chamber once you are done. Step 14: If you inhale steroid medicine, rinse your mouth with water immediately after each use and then spit it out to avoid sore throat and oral thrush.
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