The following are steps you should take to use a metered dose inhaler (MDI) with a spacer:

1. Remove the caps from both your inhaler (MDI) and spacer. Look inside the spacer to check that it is empty.
2. Shake the MDI four to five times.
3. Place the mouthpiece of the MDI into the soft rubber ring at the open end of the spacer and make sure the MDI is pointing upwards.
4. Place the spacer mouthpiece between your child's lips.
5. Press down on the MDI canister to release the medicine into the spacer. Then have your child breathe in slowly and deeply. If you hear a whistle, your child is breathing in too fast. Have your child hold his breath while you count to ten slowly.
6. Take the mouthpiece out of your child's mouth and have her breathe out slowly.
7. Wait one to three minutes before repeating steps 2 through 6 for the second puff.

Reviewed by: Paulette Taylor, RN, CPN, AE-C
Date: February 2009