Reviewed by Ann Mullen, RN, CNS, AE-C, CDE, Deborah A. Fending, RN

How do I clean my HFA inhaler?
How do I prime my HFA inhaler?
How do I use an HFA inhaler?
Can I still use a spacer/holding chamber with my HFA MDI?
How can I tell if the MDI is empty?

 

What You Need to Know about Metered-Dose Inhalers and the HFA Propellant

There are a number of ways to deliver inhaled medication. They include:

This information will focus on the metered-dose inhalers. The metered-dose inhalers contain an HFA (hydrofluoroalkane) propellant. The table below is a current list of metered-dose inhalers with the HFA propellant.

 

How do I clean my HFA MDI inhaler?

The HFA propellant in the metered-dose inhaler may build up where the metal canister meets the plastic case of the MDI. Cleaning your MDI is different depending on the medicine in the MDI. The table below describes how to clean the plastic case for each medicine with an HFA propellant.

 

How do I prime my HFA inhaler?

Priming is spraying the medicine into the air before you use the MDI. This allows for an accurate dose when you inhale the medicine. MDIs need to be primed before the first dose and when not used for a period of time. Priming your MDI is different depending on the medicine in the MDI. The table below describes how to prime the MDI with each medicine containing an HFA propellant.

HFA Inhalers

Medicine Name Brand (Generic)

Number of puffs or actuations of medicine in canister

Cleaning

Priming

Other

Bronchodilator Medicine (short-acting)

Atrovent® HFA (ipatropium)

200

  1. Take the metal canister out of the plastic case.

  2. Wash the plastic case weekly, running water through the case.

  3.  Shake off excess water.

  4.  Air dry.

  5. 5.Put the plastic case and metal canister together when completely dry.

Before first dose: 2 sprays

After 3 days of non-use: 2 sprays
 

 

ProAir HFA (albuterol)

200 Dose counter on MDI.
 

  1. Take the metal canister out of the plastic case.

  2. Wash the plastic case weekly, running water through the case.

  3.  Shake off excess water.

  4.  Air dry.

  5. Put the plastic case and metal canister together when completely dry.

Before first dose: 3 sprays

After 2 weeks of non-use: 3 sprays
 

 

Medicine Name Brand (Generic)

Number of puffs or actuations of medicine in canister

Cleaning

Priming

Other

Proventil® HFA  (albuterol)

200

  1. Take the metal canister out of the plastic case.

  2. Wash the plastic case weekly, running water through the case.

  3.  Shake off excess water.

  4.  Air dry.

  5. Put the plastic case and metal canister together when completely dry.

 

Before first dose: 4 sprays

After 2 weeks of non-use: 4 sprays
 

 

Ventolin® HFA (albuterol)

200 Dose counter on MDI.

Replace when counter gets to 000 or 6 months after opening package, whichever comes first

  1. Take the metal canister out of the plastic case.

  2. Wash the plastic case weekly, running water through the case.

  3.  Shake off excess water.

  4.  Air dry.

  5. Put the plastic case and metal canister together when completely dry.

Before first dose: 4 sprays

After 2 weeks of non-use: 4 sprays

When dropped:  4 sprays

After washing: 1 spray

.


 

Medicine Name Brand (Generic)

Number of puffs or actuations of medicine in canister

Cleaning

Priming

Other

Xopenex HFA (levalbuterol)

200

  1. Take the metal canister out of the plastic case.

  2. Wash the plastic case weekly, running water through the case.

  3.  Shake off excess water.

  4.  Air dry.

  5. Put the plastic case and metal canister together when completely dry

Before first dose: 4 sprays

After 3 days of non-use: 4 sprays
 

 

Bronchodilator Medicine (long-acting combination)

Bevespi® Aerosphere (formoterol & glycopyrrate)

120 Dose indicator on MDI.

Replace when indicator gets to 000 or 6 months after opening package, whichever comes first

  1. Take the metal canister out of the plastic case.

  2. Wash the plastic case weekly, running water through the case.

  3.  Shake off excess water.

  4.  Air dry.

  5. Put the plastic case and metal canister together when completely dry.

Before first dose: 4 sprays

After 7 days of non-use: 2 sprays
 

 


 

Medicine Name Brand (Generic)

Number of puffs or actuations of
medicine in canister

Cleaning

Priming

Other

Anti-Inflammatory Medicine

Alvesco® (ciclesonide)

60 Dose counter on MDI

Replace when counter gets to 0. If MDI dropped dose counter may not be accurate. 

  1. Avoid placing the MDI in water.

Before first dose: 3 sprays

After 10 days of non-use: 3 spray
 

Two doses available (80, 160)

Rinse mouth with water, gargle and spit out the water after using the medicine.
 

Asmanex® (mometasone)

120 Dose counter on MDI

Replace when counter gets to 000.
 

  1. Clean the mouthpiece weekly by wiping with a dry tissue or cloth.  Do not wash or put any part of the inhaler in water.

Before first dose: 4 sprays

After 5 days of non-use: r sprays
 

Two doses available (100, 200)

Rinse mouth with water, gargle and spit out the water after using the medicine.

Flovent® HFA (fluticasone)

120 Dose counter on MDI

Replace when counter gets to 000.
 
 

  1. Remove the cap. Keep the canister in the case.
  2. Wet a cotton swab. Wipe the opening where the metal canister meets the plastic case.

Before first dose: 4 sprays

After 1 week of non-use: 1 spray

When dropped:  1 spray
 

Three doses available (44, 110, 220)

Rinse mouth with water, gargle and spit out the water after using the medicine.

Store the MDI with the mouthpiece down.


 

Medicine Name Brand (Generic)

Number of puffs or actuations of medicine in canister

Cleaning

Priming

Other

Combination Anti-Inflammatory & Bronchodilator Medicine

Symbicort® (budesonide and formoterol)

120

Dose counter on MDI

Replace when counter gets to 0 (red zone) or 3 months after opening the package whichever comes first.

  1. Wipe the mouthpiece of the plastic case with a dry cloth weekly. Do not wash or put any part of the inhaler in water.

Before first dose: 2 sprays

After 7 days of non-use: 2 sprays

When dropped: 2 sprays
 

Two doses available (80, 160)

Rinse mouth with water, gargle and spit out the water after using the medicine.

Do not take the unit apart.

Store the MDI with the mouthpiece down.
 

Advair® (fluticasone and salmeterol

120 Dose counter on MDI

Replace when counter gets to 000.

 

  1. Remove the cap. Keep the canister in the case.
  2. Wet a cotton swab.  Wipe the opening where the metal canister meets the plastic case.

Before first dose: 4 sprays

After 4 weeks of non-use: 2 sprays

When dropped: 2 sprays

Three doses available (45, 115, 230)

Rinse mouth with water, gargle and spit out the water after using the medicine.
 

Dulera® (mometasone and formoterol)

120 Dose counter on MDI

Replace when counter gets to 000

  1. Wipe the mouthpiece with a dry, lint-free cloth every 7 days of use.

Before first dose: 4 sprays

After 5 days of non-use: 4 sprays
 

Two doses available (100, 200)

Rinse mouth with water, gargle and spit out the water after using the medicine.

 

 

How do I use an HFA inhaler?

Correct technique is important when inhaling your medicine with any device. Take your inhaled medicine with you when you visit the doctor.  Your doctor or nurse can watch your technique to make sure you are getting the medicine.

Remember to follow these steps when you use your MDI:

Correct technique is important when inhaling your medicine with any device. Take your inhaled medicine with you when you visit the doctor. Your doctor, nurse or pharmacist can watch your technique to make sure you are getting the medicine.

 

Remember to follow these steps when you use your MDI:

  1. Remove the cap from the inhaler.

  2. Hold the inhaler with the mouthpiece at the bottom.

  3. Shake the inhaler. This mixes the medication properly.

  4. Gently breathe out.

  5. Check the box with the technique your health care provider recommends and follow the step:

    • Use a spacer/holding chamber – Place the MDI in the spacer holding chamber.  Seal your lips around the spacer/holding chamber mouthpiece.

    • €Use open mouth technique - Hold the mouthpiece 1½ - 2 inches (3-4 finger widths) in front of your mouth.

    • €Use closed mouth technique – Place the mouthpiece in your mouth with your lips sealed tightly around the mouthpiece.

  6. Tilt your head back slightly and open your mouth wide.

  7. Begin to inhale and press the inhaler as you take in a slow, deep breath.

  8. Continue to breathe in slowly and deeply. Breathing slowly delivers the medication deeply into the airways.

  9. Hold your breath for up to ten seconds. This allows the medication time to deposit in the airways.

  10. Resume normal breathing.

  11. Repeat steps 3 - 10 when more than one puff is prescribed.

 

Can I still use a spacer/holding chamber with my HFA MDI?

aero chamberA spacer/holding chamber is a device that is placed between the MDI and your mouth.

A spacer/holding chamber can improve your MDI technique. It helps you coordinate the timing of activating the MDI and breathing in. Children and older adults may find it difficult to coordinate the timing and may find a spacer/holding chamber helpful. Anybody may find it difficult to coordinate the timing when having trouble breathing and may find a spacer/holding chamber helpful.

A spacer/holding chamber can also trap larger particles in the spacer. These particles are more likely to stay in the mouth and cause more side effects.

inhaler spacerWhen using a spacer/holding chamber with the HFA propellant the spacer/holding chamber should be anti-static. The spacer/holding chamber should also have a one-way valve to help you coordinate the timing of activating the MDI and breathing in. The space in the spacer/holding chamber should be large enough. The AeroChamber® is a common spacer/holding chamber.

 

How can I tell if the MDI is empty?

If you use your MDI every day you can keep track of how much medicine you use by Date & Estimate:

             The number of puffs in your inhaler

/            Divided by the number of puffs you take each day

          Equals the number of days the inhaler will last

Example:

            200 puffs in your inhaler

            ¸ 4 puffs a day

  50 days your inhaler will last

Once you know the number of days your inhaler will last, add the number of days to the day you start using the medicine. Along with the date you start using the inhaler, write the date you need to stop using the inhaler on the plastic case.

 

Date & Tally

If you use your MDI when you have trouble breathing you can keep track of how much medicine you use by Date & Tally:

Place a large piece of tape on the MDI. Remember to write the date you start using the MDI on the tape. Each time you use the MDI place a tally mark on the MDI (one tally mark can equal 2 puffs). You can count the tally marks to see when all the medicine has been used. You can also place tally marks on a calendar or paper near the inhaler.

Whichever technique you use, remember to figure out how long the medicine will last. Then plan ahead so that you get a new inhaler before the old one is used up.

Whichever device you use, make sure you know:

  • How to use the device

  • How to tell when the device is empty

  • How to clean the device

Also check the package insert that comes with the medicine for more information.