Okay now this part is
gonna be fun.
I want you to walk through how to
use an MDI - Metered Dose Inhaler.
So I want you to be very
clear on how to use these steps
because you're gonna have to teach a
patient very soon on how to do this.
Okay, so if the inhaler is new
or hasn't been used in a while,
the first thing that you wanna do
is to shake the inhaler, okay?
then aim it away, now if you're
looking at the picture,
see where the darker piece is
where your mouth would go?
Aim that away from you, because if you don't,
you're gonna squirt yourself in the face.
So, if it hasn't been used before, it's
brand new or haven't used it in a while,
you wanna shake the inhaler, aim it away
from you and spray 3 or 4 short puffs.
That's because we wanna make sure
the patient gets the medication
at full dose with each
Next, you wanna teach the patient to
exhale completely with a long breath
and then place the inhaler
in front of your mouth.
Okay, so you ready?
Make sure the canister is
upright, so do this with me.
Exhale completely a long breath,
then put the canister mouthpiece
in your mouth.
Okay, you're gonna have to use
your fingers just like I am,
unless you happen to
have one there with you.
So first we've shaken it up if it's brand
new or we haven't used it in a while.
Squirt it away
then I'm gonna exhale completely
put the canister in my mouth,
open my mouth,
start breathing in slow and
deep as I press down so,
then press down firmly on
the top of the canister.
That way I'm getting all the
medication in my lungs.
Okay, Now you start again
those three steps with you.
Shake it if you haven't used
it in a while,
turn it away, spray it,
then exhale completely,
put it in front of your mouth,
open your mouth,
start a deep breath and then
press down on the inhaler.
Okay. So we've made it
to the first 3 steps.
You wanna walk your patient
through these very slowly.
and as you're teaching them this, you
want them to do it along with you
without using an inhaler first.
Because you wanted to make sure that 1, they
have adequate medication available to them.
That's why you do the test sprays if it
hasn't been used for a while or it's new.
We want to empty their lungs
of as much air as possible
so the air that we are replacing it with is
full of an appropriate dose of medication.
Those are the first 3 steps.
Now the next one is the hardest.
You're gonna hold your
breath for 10 seconds.
That is not easy to do because we
always wanna short change that.
We wanna wait at least 1 minute
between puffs for the 2nd puff.
So after they've held their
breath for 10 seconds,
they can let it out and then you
want them to wait in between.
Now an important point about this
type of medication administration,
if I have two types of medications
which you know I will, alright.
I'm gonna have a medication that treats
bronchoconstriction that will open airways
and I'm gonna have a medication
that deals with inflammation.
So here's a question for you.
Which one of these medications
should I give first?
the inhaled glucocorticoid or
corticosteroid, the anti-inflammatory
or should I take the
Okay. Well the correct answer is
you always wanna take the
Because if you take that bronchodilator
first, it'll open up those airways,
you wait time in between
now when I give the anti-inflammatory it's gonna
get tucked down into all those nooks and crannies.
Remember, you wanna give it time to work.
So for some medications, one
minute isn't really enough.
You wanna give it maybe 3 or 4 minutes, have
that medication really start kicking in.
So 5 minutes between a bronchodilator and an
anti-inflammatory is really what we recommend.
Now I wanna go back through
those steps again,
Let's see if you can do
that from the beginning.
Okay, so step 1,
we know inhaler.
If I just took it in the
morning, I'm probably okay.
but if it's brand knew or haven't used it
at all, then you do these steps with me.
I'm going to shake it,
turn it away from me,
I'm gonna squirt 2,3,4 puffs just to
make sure the medication is down there.
Then I'm gonna do what?
Right, exhale completely.
Put the inhaler here,
open my mouth,
(start breathing in slow and deep
and then press the canister.
Wow, that is a long time.
Okay, now I want you to do
that with your patients.
The next time you have a patient with a metered
dose inhaler, check them on how they do that.
You would be amazed.
Even in my own family, I've had to work with
people very delicately as you can understand.
But I want you to do is make sure you know these
6 key things about using a metered dose inhaler.
You can do it yourself and did
you see how long 10 seconds was?
Most patients don't do that
for 10 seconds.
But you want them to understand,
holding your breath like that
would really give that medication a chance to
get in there and do what it's supposed to do.
So practice that before
you go to clinicals,
before you're in a setting where you're
gonna teach a patient with that.
Do it with them and
help them know,
"Listen, this is gonna be the longest 10 seconds in
your life but it's really important that you do that."
So that's how you teach a patient
how to use a metered dose inhaler.