Aerosol Guide - AARC.org

Technique Box 2. Steps for Correct Use of pMDIs (continued)
Closed-mouth Technique: (continued)
9. Hold their breath for 10 seconds. If they cannot hold their breath for 10 seconds, then for
as long as possible.
10. Wait one minute if another puff of medicine is needed.
11. Repeat Steps 2–10 until the dosage prescribed by the patient’s physician is reached.
12. If taking a corticosteroid, she/he should rinse the mouth after the last puff of medicine,
spit out the water and not swallow it.
13. Replace the mouthpiece cover on the pMDI after each use.
Breath-actuated pMDI (Autohaler) Technique: When using the Autohaler, the patient
should be instructed to:
1. Warm the pMDI canister to hand or body temperature.
2. Remove the mouthpiece cover and check for foreign objects.
3. Keep the Autohaler in a vertical position while the arrow points up, and do not block
the air vents.
4. Prime the Autohaler into the air if it is new or has not been used recently.
5. Push the lever up.
6. Push the white test fire slide on the bottom of the mouthpiece for priming the
Autohaler.
7. Push the lever down in order to release the second priming spray.
8. Return the lever to its down position and raise the lever so that it snaps into place.
9. Sit up straight or stand up.
10. Shake the Autohaler three or four times.
11. Breathe out normally, away from the Autohaler.
12. Place the pMDI between their teeth. Make sure that their tongue is flat under the mouthpiece
and does not block the pMDI.
13. Seal their lips around the mouthpiece.
14. Inhale deeply through the mouthpiece with steady moderate force,
15. Pay attention to the click sound and the feel of a soft puff when the Autohaler triggers
the release of medicine.
16. Continue to inhale until the lungs are full.
17. Remove the mouthpiece from the mouth.
18. Hold breath for 10 seconds or as long as possible.
19. Repeat steps above until the dosage prescribed by the patient’s physician is reached.
20. Replace the mouthpiece cover and make sure the lever is down.
Soft Mist pMDI (Respimat) Technique: When using the Respimat, the patient should be
instructed to:
Preparation:
1. With the orange cap closed, press the safety catch while pulling off the clear base. Be careful
not to touch the piercing element located inside the bottom of the clear base.
2. Push the narrow end of the cartridge into the inhaler. The base of the cartridge will not sit
flush with the inhaler. About 1/8 of an inch will remain visible when the cartridge is correctly
inserted.
3. The cartridge can be pushed against a firm surface to ensure it is correctly inserted.
4. Do not remove the cartridge once it has been inserted into the inhaler.
5. Write the discard by date on the label of the inhaler. The discard by date is 3 months from
the date the cartridge is inserted.
6. Put the clear base back into place. Do not remove the clear base again. The inhaler should
not be taken apart after they have inserted the cartridge and put the clear base back.
Priming
7. Hold the inhaler upright with the orange cap closed to avoid accidental release of dose.
8. Turn the clear base in the direction of the white arrows on the label until it clicks (half a
turn).
9. Flip the orange cap until it snaps fully open.
30 American Association for Respiratory Care A Guide to Aerosol Delivery Devices for Respiratory Therapists, 3rd Edition © 2013