One type of inhalation device for delivering drugs is metered-dose inhalers (MDIs).

When this type

of inhaler is utilized, nurses must give thorough, complete, and age-appropriate instructions regarding the
correct use of the equipment. For some patients, considering their age and condition, it might be difficult
to use this type of inhaler because it requires hand-breath coordination. Aside from this, even when the
inhaler is used correctly, only 10% of the dose reach the lungs as most of the drug is deposited on the
oropharyngeal mucosa. This local deposition can be of serious concern when the type of drug to be
administered is accounted for, specifically inhaled glucocorticoids where oropharyngeal candidiasis and
dysphonia are common adverse effects. To increase delivery of drug to its site of action in the lungs, a
spacer may be used. A spacer is a device that can be attached to the mouthpiece. Different kinds of
spacers are available for use. One kind of spacer contains a one-way valve that activates upon inhalation
providing client an opportunity to take several deep breaths in order to inhale all of the medication
without the need for coordinating inhalation with MDI activation. Another type has an alarm whistle that
sounds off when inhalation is too rapid.
To use a spacer with an inhaler, attach it to the mouthpiece of the inhaler after shaking the MDI
and removing the inhaler cap. Place the mouthpiece in the patient’s mouth. Have the patient exhale,
then press down on the inhaler to release the medication. Have the patient inhale deeply and slowly for
two to three seconds, and then hold his/her breath for ten seconds. Wait for 1 to 2 minutes between
puffs if a second puff of the same drug is ordered. If a different type of inhaled medication is ordered,
wait for 2-5 minutes between medication inhalations or as prescribed.