An inhaler or MDI (metered dose inhaler) is a pressurized canister that administers prescribed medications in aerosol form. It has become more popular recently because of its price and its convenience.

Following these 10 simple steps can help you use your inhaler effectively:

1. Shake the inhaler for at least 10 seconds and remove the protective cap. The metal canister should be on top and the mouthpiece on the bottom.

2. Hold the inhaler properly by placing your index and middle fingers on the top of the metal canister and your thumb on the bottom of the plastic mouthpiece (see drawing). Breathe out normally.

3. With your head erect, place the inhaler about 1 to 1-1/2 inches in front of your open mouth.

4. As you begin to breathe in deeply through your mouth, press the metal canister down with your index and middle fingers. Try to breathe in very deeply to carry the particles of medicine as far down into your lungs as possible.

5. Hold your breath for at least 10 seconds or as long as it's comfortable. This allows time for the medication to travel through the breathing passages and deposit further in the lungs.

6. Slowly exhale through pursed lips and continue to breathe normally.

7. If your doctor has prescribed more than one puff per treatment, wait a few minutes between doses. Some inhalers specify a longer waiting period, so follow your doctor's instructions carefully. Never exceed the inhaler dosage prescribed by your doctor without consulting him first.

8. Replace the cap on the inhaler when you're finished. Wash the mouthpiece and cap daily in warm water and dry thoroughly.

9. After each treatment, rinse your mouth with water or your favorite mouthwash. *(See "Timing is Everything.")

10. Remember, don't puncture or destroy your inhaler by fire because its contents are under pressure. Also, don't store or use the inhaler near heat or an open flame.

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Inhaler Accessories

Over the past few years, prescribed inhalers have become a major method for delivering medication when you have COPD. However, not everyone is capable of using their inhaler efficiently and effectively using the technique previously described. There are now available on the market today a number of accessories that can help you get the most from your inhaled medication. Whether you are older, or have arthritis, or just cannot coordinate this activity, you may find that a spacer or other device can help. They are relatively affordable and allow you to maximize the medication in your inhaler.

Spacers......a spacer is a generic term used to describe a holding chamber for your medication after it has left your inhaler. Brands on the market today are Inspirease® and Aerochamber®. These devices allow you to take your inhaled medication at your own pace. They're especially beneficial for those individuals who have difficulty coordinating their breathing with administering their medication. You attach your inhaler to the chamber following manufacturer's directions. Check with your pharmacist for availability.

Other devices.....another unique accessory for individuals who have dexterity problems (weak hands/fingers) is the Ventease®. This little gadget attaches to certain inhaler mouthpieces and makes depression of the cannister easier. Check with your doctor or pharmacist.

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Timing is everything!!

Many of you use more than one inhaler at a time. How do you decide what to take first? How long should you wait between each puff? between each medicine? Good question. Bronchodilators work faster than inhaled steroids. As a general rule, use the fastest acting bronchodilator first (e.g. Proventil®, Ventolin®, Alupent®, Maxair®, Brethaire®). Follow this with the next fastest acting bronchodilator, if prescribed (e.g. Atrovent®). Finally, follow with your inhaled steroid (e.g. Vanceril®, Beclovent®, Azmacort®, Aerobid®).

Below is a chart that gives you an idea how to set up your inhaled medicines regarding proper timing and sequencing. Read this over carefully and substiture your inhalers in the proper spaces. This is for guidance only and you should always consult your physician to adjust and tailor this to your own needs: