–Introduction Music Plays– All MDIs require a slow, deep inhalation. There are 3 different techniques that can be used to deliver the medicine, within each MDI, into the lungs. Let’s watch as Casey describes and demonstrates how to use the MDI to Mrs. Ryan, using the device with the spacer, using the 2-finger breadth method, and the closed-mouth technique. Hello, Mrs. Ryan, I’m Casey. Hi, Casey. I’m here today to show you how to use a new inhaler called a metered dose inhaler. Ok. This is what your clinician has prescribed and I want to show you how to use this. Ok. Metered dose inhalers have been around for many years, but there are actually 3 different ways that we like for you to use it, so it’s a little bit trickier than you think. Wow. The first one is we want for patients to use a spacer device. Now a spacer device, as you can see, is usually a plastic tube. There’s one that’s a metal one, but this plastic tube is important because it helps patients in a number of different ways. The 1st thing is it helps with coordination, as you’ll see as you practice with the metered dose inhaler, it’s a little tough to coordinate the timing of it. The 2nd one is it helps sort out some of the particle sizes to be just the right particle size to go to your lungs. Ok. The last one is that it decreases some of the side effects that you can get from the medications that come in the metered dose inhaler. So, now let’s show you how to use it. The 1st thing, as you can see, there’s a cap over the mouthpiece that you open up to get ready to use your spacer. Good. Now, for your metered dose inhaler, there’s a dust cap over the mouth piece, take that off. With the metered dose inhaler you want to make sure you always shake it well. So shake. Now you’re going to place it in the end of your spacer. So you’re going to push this into the spacer. All right, now it’s ready to go. What you’ll do is you’re going to load 1 dose into the spacer by pushing down the canister. You only do 1 dose at a time, not more than 1. It’s sometimes easier to think you can be faster, but only 1 dose at a time. Ok. And as you can see with this one, this chamber will hold that medication in there, because there’s a 1-way valve that the medication will come out only when you breathe in. Oh, good. So push the, all right, now we’re going to breathe in, breathe in slowly, like you’re sipping hot soup. Hold your breath for 10 seconds, and then exhale. Now if you breathe in too quickly, this is what will happen. It’ll whistle on you. So whistling tells you you inhaled too quickly, so slow down. So I always say like sipping hot soup. Now if you need a 2nd dose wait about a minute, shake it up good again, put it back in, fire the dose, push down that canister, and once again exhale. Inhale. Now how do you take care of these? Well that’s a good question. With the spacers you need to, when you first get it, and then also once a month, you need to rinse it in warm soapy water. So wash it in warm soapy water, and then you let it air dry. So, believe it or not, you do not rinse it with the cold water, you don’t rinse it off. The soap bubbles help the medication from sticking to the sides of the plastic, So the medication can get to your lungs and not on the side of the plastic. So warm, soapy water, and just let it air dry and don’t rinse it out. Now do I do that every time I use that? Once a month. Once a month, wow. Ok, in between I don’t have to clean it? No, luckily not. If you need to wipe off the mouthpiece with a cloth, that’s fine. Ok. So now what happens with the metered dose inhaler, for one thing, sometimes this little nozzle on the end can clog up. So if it does, what you can do is take your canister out. This one doesn’t go in water, and you can put this and run it under some warm water. Not soapy water, because obviously you’d be inhaling directly from here, so warm water, swish it around. Oh, Ok. If it still looks a little gummy you can take a Q-tip or a cotton-tip applicator, and work on that nozzle area. Ok. As you can see here, it has your expiration date on your canister, so that kind of gives you a good hint on when to get rid of it. And lastly, you can put it back together. Now metered dose inhalers, some of them have counters and some of them do not. So it depends on which medication that your clinician has prescribed. The counter will be either on the backside here, or it’ll be on the top of your canister. But if not, you’ll have to count the doses, and counting the doses means you have to put it on your calendar, or know how many times you used it. I see. So how many doses does this hold? Usually about 200, unless it’s a sample. Ok. 200 doses is average, some of them are a little different, but they’ll let you know. Ok. Any questions about these 2? I don’t think so. Now why don’t you demonstrate to me how to use the metered dose inhaler with the spacer. Ok. Shake it like this. Good. And this goes in here, and then I put the medication in like that. Correct Excellent, excellent. Now some of these spacers do not have a one-way valve and it’ll be open to air, and for those you have to make sure that you have the mouthpiece in your mouth, as you fire your medication. Ok. But luckily this one has the one-way valve in it. Right. To make it easier. Ok. And how would you clean this device? Ok, I’m going to rinse this in warm, soapy water once a month. Correct. And then let it air dry like that. Perfect. And if you’re metered dose inhaler gets clogged what would you do? Then I can pull this out and rinse this out in just warm water, not soapy, because this is going in my mouth. And then I can use a Q-tip if it’s still clogged up around there. Correct. Now I want to show you how to use a metered dose inhaler with a different technique. This would be the 2nd most preferred way, the 1st is with the spacer, the 2nd is called the 2-finger breadth method. Ok. This one’s not for everybody. Some patients find it difficult and they don’t like this method, but for others it works. Ok. So what you do is you take your metered dose inhaler, you take off the end cap, you shake your metered dose inhaler well, like you always should. You’re going to be placing this metered dose inhaler 2-finger breadths from your mouth. So this is called the open-mouth, or the 2-finger breadth method. 2 finger breadths from your mouth, you’re going to exhale, and as you start to inhale, fire that medication. You did well. I kind of felt a bunch of it hit my cheek over here. It’s a difficult one to coordinate, so it’s one that it helps with side effects and helps the particle size, but it is more difficult to coordinate. You want to show me how to do that one more time? Ok. Try not to do my cheek this time. Excellent, excellent. Wow. And the last method is the one that’s in the medication inserts, is showing you, take off your dust cap, you shake it, and this one you put just directly in your mouth, sealing your mouth around it, it’s called the closed-mouth. Exhale, inhale. Excellent. You can really feel the medication going in that way. Yes, but a lot of times that’s what patients feel but actually it’s the propellent more than the medication that makes that sensation in the back of your throat. That makes sense. Good, you want to show me one more time how to do that closed-mouth method? Ok. Excellent. Then you hold it in for ten minutes. Ten seconds. Ten seconds, ten minutes would be really good. So any questions? I don’t think so Casey, it’s kind of complicated, but I’ve got your phone number. Good.