Albuterol inhaler without spacer

<< RESPIRATORY

Considerations:

  • Attempt to provide the student with as much privacy as possible, given the urgency of the situation
  • For children the use of a valved holding chamber (spacer) is optimal to ensure proper medication delivery.
  • The school nurse should develop a plan to systematically check the expiration date on the medication to ensure the medication has not expired.

Supplies:

  • Inhaler
  • Student’s Individualized Health Plan
  • Asthma Action Plan and/or healthcare provider’s order
  • Parent/Guardian authorization form
Procedure Download
Skill Competency Download

Instructions for inhaler administration without spacer:

  1. Gather needed supplies and place on a clean surface
  2. Position student, providing as much privacy as possible
  3. Wash hands
  4. If student will be administering medication, have student wash hands
  5. Check for authorization forms or record. Review the medication administration form, the medical provider form, and the parent/guardian authorization form.
  6. Review the six rights of medication administration to be sure it is:
    1. For the right student
    2. The right medication
    3. The right dose
    4. Being given at the correct time
    5. Being given by the right route
    6. Being given for the right reason
  7. Be sure to check the medication to ensure that it has not expired
  8. Review the student’s allergy status
  9. Make sure the inhaler and spacer are free of foreign objects
  10. Shake the inhaler for 5 seconds to mix the medicine
  11. Remove the cap from the mouthpiece
  12. Prime the inhaler if indicated (if the inhaler is new or has not been used in the past 7 days or if it has been dropped)
    • When the MDI is brand new or has not been used for a while, the medication may separate from the other ingredients in the canister and the metering chamber. Shaking the MDI will mix the ingredients in the drug reservoir but may not produce enough turbulence to re-blend the ingredients in the metering chamber. Priming, or releasing one or more sprays into the air, ensures your next dose will contain the labeled amount of medication
  13. Review the six rights of medication administration again to be sure it is:
    1. For the right student
    2. The right medication
    3. The right dose
    4. Being given at the right time
    5. Being given by the right route
    6. Being given for the right reason
  14. Hold the inhaler between your index finger and thumb
  15. Have the student stand up and take a deep breath in, and breathe out
  16. Have the student tip their head back slightly towards the ceiling
  17. Have the student put the inhaler in their mouth, between their teeth and above their tongue
  18. Have the student close their lips around the inhaler
  19. Press down on the top of the inhaler once as the student breathes in very slowly until they have taken a full breath
  20. Instruct the student to hold their breath for 5 to 10 seconds
  21. Instruct the student to breathe out slowly through their mouth
  22. Wait 1 minute before having the student take a second puff, if ordered
  23. Repeat previous steps if taking a second puff
  24. Have student rinse out their mouth with water and spit, as needed
  25. Wash hands
  26. Document medication administration in student’s medication administration log
  27. Follow up, as needed, with parents or guardian and healthcare provider 

Cleaning the inhaler:

  1. Remove the canister from the actuator
  2. Run warm water through the top and bottom of plastic actuator (do not boil or place the actuator in the dishwasher)
  3. Shake off the excess water
  4. Allow the actuator to air dry on a clean surface prior to putting canister back in

References: 

American Lung Association. (2019). How to use your inhaler and spacer. Available at: https://www.lung.org/getmedia/1a58adde-c10a-4925-bd89-cd5c61767897/how-to-use-your-inhaler-and.pdf.pdf. Accessed April 14, 2020.

American Lung Association. (2019). How to use a metered-dose inhaler. Available at: https://www.lung.org/getmedia/958e9666-07f9-4c28-a439-223e143f0ecf/how-to-use-a-metered-dose.pdf.pdf. Accessed April 14, 2020.

American Lung Association. (2020). How to use a metered dose inhaler . Available at: https://www.lung.org/lung-health-diseases/lung-disease-lookup/asthma/patient-resources-and-videos/videos/how-to-use-a-metered-dose-inhaler

American Lung Association. (2020). How to use a metered-dose inhaler with a spacer or valved holding chamber . Available at: https://www.lung.org/lung-health-diseases/lung-disease-lookup/asthma/patient-resources-and-videos/videos/how-to-use-a-metered-dose-inhaler. Retrieved April 14, 2020.

Butler, S.M., Boucher, E.A., Tobison, J., & Phan, H. (2020). Medication use in schools: Current trends, challenges, and best practices. J Pediatr Pharmacol Ther., 25(1): 7–24. doi: 10.5863/1551-6776-25.1.7

Center for Disease Control. (2018). Know how to use your asthma inhaler using a metered dose inhaler (inhaler in mouth). Available at: https://www.cdc.gov/asthma/pdfs/Inhaler_in_Mouth_FactSheet.pdf. Retrieved: April 30, 2020.

Corjulo, M. (2011). Mastering the metered-dose inhaler: An essential step toward improving asthma control in school. NASN School Nurse, 26, 285.

Fanta, C.H. (2020). An overview of asthma management. In a R.A. Wood and B.S. Bochner (Ed.), UpToDate. Retrieved: April 7, 2020.

National Asthma Education and Prevention Program. (2011). Management of asthma exacerbations: School treatment: Suggested emergency nursing protocol for students with asthma symptoms who don’t have a personal asthma action plan. Available at: https://www.nhlbi.nih.gov/files/docs/resources/lung/sch-emer-actplan.pdf Retrieved: May 1, 2020.

Prescribers’ Drug Reference (PDR). 2020. Albuterol sulfate – drug summary. Available at: https://www.pdr.net/drug-summary/Albuterol-Sulfate-Inhalation-Solution-0-083-albuterol-sulfate-1427. Retrieved: April 15, 2020.

Page last reviewed: February 28, 2025

Page last updated on: February 28, 2025

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