Aerosols in the Health Care Field

:: Section 3

Optimal Technique

As there are many variables that can affect the performance, for better results, the following steps should be followed in operating a MDI.

1. Warm the MDI canister to hand or body temperature (to avoid the cold aerosol effect). Shake the canister vigorously to allow homogeneous doses
2. Assemble the apparatus, and uncap the mouthpiece. To avoid foreign objects entering the mouth, check to ensure there are no loose objects
3. Open the mouth wide and keep the tongue down
4. Hold the MDI with the canister oriented downward.  Aim the outlet at the mouth
5. Position the MDI approximately 4 cm (two finger breadths) away from the mouth to allow evaporation of the propellant
6. Breath out normally
7. Begin breathing in slowly (less than 0.5 L/s) and then activate (fire) the MDI.  Continue inspiration to full breath
8. Hold the breath for about 10 seconds
9. Wait 1 minute before the next puff
10. Disassemble the apparatus, and recap the mouthpiece

If a holding chamber is used:

1. Follow the same first two steps above
2. Hold the canister vertically. Shake it vigorously
3. Place the mouthpiece in the mouth, and breathe through the mouth.  If a mask is used, place it over the nose and mouth.
4. Breathe normally. Actuate of the MDI when starting inspiration. Continue to breathe through the device for 3 breaths
5. Wait for 30 to 60 seconds before the next actuation

Click to watch the movie for operating a MDI.