Inhaler With Spacer



  • Attempt to provide the student with as much privacy as possible, given the urgency of the situation

Needed supplies:

  • Inhaler
  • Spacer
  • Student’s Individualized Health Plan/Asthma Action Plan and/or healthcare provider’s order

This video was developed in partnership with the Wisconsin Department of Public Instruction


  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 consent form.
  6. Check for the albuterol and order to be sure it is”
    1. For the right child
    2. The right medication
    3. The right dose
    4. Being given at the correct time
    5. Being given by the right route
  7. Be sure to check the medication to ensure that it has not expired
  8. Make sure the inhaler and spacer are free of foreign objects
  9. Shake the inhaler for 10 seconds to mix the medicine
  10. Remove the cap from the mouthpiece
  11. Prime the inhaler if indicated
    1. 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
  12. Quickly review the five rights once again while checking the albuterol to be sure it is:
    1. For the right child
    2. The right medication
    3. The right dose
    4. Being given at the right time
    5. Being given by the right route
  13. Place the inhaler mouthpiece onto the end of the spacer
  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 place the spacer between their teeth and place their lips around it (follow the individual spacer instructions)
  17. Press down on the top of the inhaler once
  18. Instruct the student to breathe in very slowly until they have taken a full breath
  19. If you hear a whistle sound, instruct the student to breathe slower—the breath in should take at least 3 to 5 seconds
  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 earlier 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

Procedure for Cleaning the Spacer

  1. It is recommended to clean the spacer every 1 to 2 weeks, or more often if needed.
  2. Remove the mouthpiece and the rubber piece that holds the inhaler
  3. Soak the mouthpiece, rubber piece and plastic chamber in warm water and a small amount of dish soap
  4. Rinse with clean water
  5. Shake off excess water and dry on a clean surface in a vertical position, with the mouthpiece side up
  6. Do not dry with a cloth or paper towel
  7. Once dry, store in a clean container or bag


American Lung Association. (2022, November 17). How to use your inhaler and spacer. Available at: Accessed August 7, 2023.

American Lung Association. (2022, November 17). How to use a metered-dose inhaler. Available at: Accessed August 7, 2023.

American Lung Association. (2022, November 17). How to use a metered dose inhaler . Available at:

American Lung Association. (2022, November 17). How to use a metered-dose inhaler with a spacer or valved holding chamber . Available at: 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: 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: Retrieved: May 1, 2020.

Prescribers’ Drug Reference (PDR). 2020. Albuterol sulfate – drug summary. Available at: Retrieved: April 15, 2020.

Page last updated on: March 15, 2021

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.