Considerations:
- Attempt to provide the student with as much privacy as possible, given the urgency of the situation
- The school nurse should develop a system to systematically check the expiration date on the medication to ensure it has not expired
Needed supplies:
- Inhaler
- Spacer
- Student’s Individualized Health Plan
- Asthma Action Plan and/or healthcare provider’s order
- Parent/Guardian authorization form
Procedure:
- Gather needed supplies and place on a clean surface
- Position student, providing as much privacy as possible
- Wash hands
- If student will be administering medication, have student wash hands
- Check for authorization forms or record. Review the medication administration form, the medical provider form, and the parent/guardian authorization form.
- Review the six rights of medication administration to be sure it is:
- For the right student
- The right medication
- The right dose
- Being given at the correct time
- Being given by the right route
- Being given for the right reason
- Be sure to check the medication to ensure that it has not expired
- Review student’s allergy status
- Make sure the inhaler and spacer are free of foreign objects
- Shake the inhaler for 10 seconds to mix the medicine
- Remove the cap from the inhaler mouthpiece
- Prime the inhaler if indicated (if the inhaler is new or has not been used in the past 7 days or if the inhaler 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
- Review the six rights of medication administration again to be sure it is:
- For the right student
- The right medication
- The right dose
- Being given at the right time
- Being given by the right route
- Being given for the right reason
- Place the inhaler mouthpiece onto the end of the spacer (opposite the mouthpiece)
- Remove cap from spacer
- Hold the inhaler between your index finger and thumb
- Have the student stand up and take a deep breath in, and breathe out
- Have the student tip their head back slightly toward the ceiling
- Have the student place the spacer between their teeth and their tongue
- Have the student close their lips around it (follow the individual spacer instructions)
- Press down on the top of the inhaler once
- Instruct the student to breathe in very slowly until they have taken a full breath
- If you hear a whistle sound, instruct the student to breathe slower—the breath in should take at least 3 to 5 seconds
- Instruct the student to hold their breath for 10 seconds
- Instruct the student to breathe out slowly through their mouth
- Wait 1 minute before having the student take a second puff, if ordered
- Repeat earlier steps if taking a second puff
- Have student rinse out their mouth with water and spit, as needed
- Wash hands
- Document medication administration in student’s medication administration log
- Follow up, as needed, with parents or guardian and healthcare provider
Cleaning the inhaler:
- Remove the canister from the actuator
- Run warm water through the top and bottom of plastic actuator (do not boil or place the actuator in the dishwasher)
- Shake off the excess water
- Allow the actuator to air dry on a clean surface prior to putting canister back in
Procedure for Cleaning the Spacer
- It is recommended to clean the spacer every 1 to 2 weeks, or more often if needed.
- Remove the mouthpiece and the rubber piece that holds the inhaler
- Soak the mouthpiece, rubber piece and plastic chamber in warm water and a small amount of dish soap
- Rinse with clean water
- Shake off excess water and dry on a clean surface in a vertical position, with the mouthpiece side up
- Do not dry with a cloth or paper towel
- Once dry, store in a clean container or bag
References:
American Lung Association. (2019, April). How to use your inhaler and spacer. Retrieved May 24, 2023, from https://www.lung.org/getmedia/21c7dabe-795c-4576-9bbc-6f6bb9fcad06/ala-how-to-inhaler-v4.pdf
American Lung Association. (2022, September). How to use a metered-dose inhaler without a valved holding chamber or spacer. Retrieved May 24, 2023, from https://www.lung.org/getmedia/1aa45911-f79f-44ef-a348-08e089e1a57c/MDI-one-pager.pdf?ext=.pdf
American Lung Association. (2022). How to use a metered dose inhaler . Retrieved May 24, 2023, from https://www.lung.org/lung-health-diseases/lung-disease-lookup/asthma/treatment/devices/metered-dose-inhaler
American Lung Association. (2022, November 17). How to use a metered-dose inhaler with a spacer or valved holding chamber . Retrieved May 24, 2023, from https://www.lung.org/lung-health-diseases/lung-disease-lookup/asthma/treatment/devices/metered-dose-inhaler-chamber-spacer
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
Centers for Disease Control and Prevention. (n.d.). Know how to use your asthma inhaler using a metered dose inhaler: Using a metered dose inhaler (inhaler in mouth). Retrieved May 24, 2023, from https://www.cdc.gov/asthma/pdfs/Inhaler_in_Mouth_FactSheet.pdf
Centers for Disease Control and Prevention. (n.d.). Know how to use your asthma inhaler using a metered dose inhaler: Using a metered dose inhaler with spacer. Retrieved May 24, 2023, from https://www.cdc.gov/asthma/pdfs/Inhaler_Spacer_FactSheet.pdf
Centers for Disease Control and Prevention. (2022, December 12). Using a metered dose inhaler with spacer . Retrieved May 24, 2023, from https://www.cdc.gov/asthma/inhaler_video/default.htm
Center for Disease Control and Prevention. (2022, December 12). Using a metered dose inhaler (inhaler in mouth) . Retrieved May 24, 2023, from https://www.cdc.gov/asthma/inhaler_video/default.htm
Children’s Hospital St. Louis. (n.d.) For kids: How to use a metered-dose inhaler with a spacer. Retrieved June 7, 2023, from https://stlouischildrens.staywellsolutionsonline.com/MultimediaRoom/VideoLibrary/?e=0#player:138,K1995
Fanta, C.H., & Barrett, N.A. (2023, April 4). An overview of asthma management. In a R.A. Wood and B.S. Bochner (Ed.), UpToDate. Retrieved: May 24, 2023, from https://www.uptodate.com/contents/an-overview-of-asthma-management
Lynn, P. (2019). Administering medication via a metered-dose-inhaler (MDI) In Skill checklists for Taylor’s clinical nursing skills. A nursing process approach. (5th ed.). (pp. 116-118).
Perry, A. G., Potter, P.A., Ostendorf, W., & Laplante, N. (2021). Nonparenteral medications. In Clinical nursing skills and techniques. (10th ed.). (pp. 637-640). St. Louis, MO: Elsevier.
Prescribers’ Drug Reference (PDR). (2023). Albuterol sulfate – drug summary. Retrieved May 24, 2023, from https://www.pdr.net/drug-summary/Albuterol-Sulfate-Inhalation-Solution-0-083-albuterol-sulfate-1427
Page last reviewed: February 28, 2025
Page last updated on: February 28, 2025
The information and materials presented in this Website are intended for informational purposes only and are not designed to diagnose or treat a health problem or disease, or assist in diagnosis or treatment of the same. The information is not intended to substitute for, supplement or replace clinical judgment. If there are any concerns or questions about or relating to a nursing or medical procedure, contact the individual’s healthcare provider. The information provided on this Website is not intended to be a substitute for medical orders and persons without the proper education, training, supervision and/or licensure should not perform the procedures.