On this page
- What is an asthma inhaler?
- Metered dose inhalers (puffers)
- Autohalers
- Other types of inhaler (dry powder inhalers)
- Check list for good usage
- Where to get help
- Related information on Australian websites
If you have asthma, you may need to use one or more asthma medications to manage the condition. It is important that you use your asthma inhaler correctly to get the full benefit of the medication you are taking.
Most people with asthma, however, do not use the correct technique.
What is an asthma inhaler?
Most asthma medicines are inhaled through the mouth using an inhaler or puffer. There are several types and the device you use will depend on your age, how your lungs work and which device you find easiest to use. A doctor, pharmacist or nurse should show you how to take your asthma medicine.
Some medicines are breathed in directly from the inhaler; others are breathed in through a 'spacer' — you puff the medicine into a container and breathe through a mouthpiece at the other end.
This increases the amount of medicine that reaches the small airways of the lungs.
Most children over 4 can use a small spacer and puffer. Babies and children under 4 may need a face mask.
(The videos below and more can be found on the NPS MedicineWise YouTube page.)
Metered dose inhalers (puffers)
A puffer, or a metered dose inhaler, is the most common type of inhaler. Using it with a spacer will get more medicine into the lungs.
Tips for correct use
- Shake the inhaler before use.
- Breathe out fully.
- Hold the inhaler in the right position.
- Breathe in deeply as you puff the medicine into your mouth, then hold your breath for as long as possible (and for at least 5 seconds).
- Make sure you shake the inhaler in between puffs.
Video: how to use a puffer
Video: how to use a puffer with a spacer
Autohalers
An Autohaler is an alternative way to take some asthma medicines. The inhaler is activated by breathing in.
Tips for correct use
- Make sure you hold the inhaler in the right position.
- Breathe out fully before you breathe in, and continue to breathe in after you hear the click.
- Try not to breathe out into the inhaler and replace the cap after use.
- Make sure you shake the inhaler in between puffs.
Video: how to use an Autohaler
Other types of inhaler (dry powder inhalers)
There are many other types of inhaler. These include the Accuhaler, Turbuhaler, HandiHaler, Ellipta and Genuair. These inhalers all come with instructions. A doctor or nurse should teach you how to use them.
Tips for correct use
- Make sure you do not tilt the inhaler while you are loading the dose.
- Breathe out fully before you breathe in, and make sure you breathe in with a strong, complete breath.
- Do not breathe out into the inhaler.
- Make sure you close the inhaler after you use it.
Video: how to use an Accuhaler
Video: how to use a Turbuhaler
Video: how to use a HandiHaler
Check list for good usage
- Ask a health professional to demonstrate how to use your inhaler and check your technique.
- Make sure the inhaler is not past its expiry date.
- Make sure your inhaler is not empty.
- If you are using a spacer, make sure it is clean — visit the Australian Asthma Handbook for recommendations on how to clean a spacer.
Where to get help
The following organisations have a range of resources, including fact sheets and videos to help you take your asthma medicine properly:
- The National Asthma Council Australia website for more information and videos, including their My Asthma Guide for practical strategies to help you understand and manage your asthma.
- Asthma Australia for more information and videos.
- NPS MedicineWise YouTube page for more videos on how to use asthma inhalers.
The nurse is caring for a client with chronic bronchitis who has a new prescription for a combined fluticasone and salmeterol inhaler and the client asks the nurse the purpose of using two drugs. Which of the following information is the basis for the nurse's response?
One drug decreases inflammation, and the other is a bronchodilator.
The nurse has received a change-of-shift report about the following clients with chronic obstructive pulmonary disease (COPD). Which client should the nurse assess first?
a. A client with a respiratory rate of 38
b. A client with loud expiratory wheezes
c. A client with jugular vein distension and peripheral edema
d. A client who has a cough productive of thick, green mucus
A client with a respiratory rate of 38
The nurse has completed client teaching about the administration of salmeterol using a
metered-dose inhaler (MDI). Which of the following actions by the client indicates good
understanding of the teaching?
The client attaches a spacer before using the MDI.
The nurse is preparing a client with possible asthma for pulmonary function testing. Which of the following instructions should the nurse include in the teaching plan?
Withhold bronchodilators for 6-12 hours before the examination.
The nurse is caring for a client with asthma who has a baseline peak flow reading of 600 mL and calls the nurse, stating that the current peak flow is 420 mL. Which of the following actions should the nurse take first?
Instruct the client to use the prescribed albuterol.
Which of the following information should the nurse include when teaching the client with asthma about the prescribed medications?
Tremors are an expected adverse effect of rapidly acting bronchodilators.
The nurse is teaching a client about continuous home oxygen use and cautions the client to take extra care to not run out of oxygen. Which of the following seasons should the nurse
instruct the client has the highest rate of oxygen evaporation?
The nurse is evaluating the effectiveness of therapy for a client who has received treatment during an asthma attack. Which of the following findings is the best indicator that the therapy has been effective?
Oxygen saturation is >92%.
Which of the following actions should the nurse anticipate taking first when a client who is experiencing an asthma attack develops bradycardia and a decrease in wheezing?
Assist with endotracheal intubation.
The nurse is caring for a client in the emergency department who is experiencing an acute asthma attack. After listening to the client's breath sounds, which of the following actions should the nurse take next?
Obtain the forced expiratory volume (FEV) flow rate.
The nurse is caring for a client with a history of asthma. Which of the following assessments finding should the nurse communicate immediately to the health care provider?
Use of accessory muscles in breathing
The nurse is caring for a client with chronic bronchitis who has a nursing diagnosis of impaired breathing pattern related to anxiety. Which of the following nursing actions is best to include in the plan of care?
Teach the client how to effectively use pursed lip breathing.
The nurse is caring for a client with chronic obstructive pulmonary disease (COPD) who has a nursing diagnosis of imbalanced nutrition: less than body requirements. Which of the following interventions is best to address this problem?
Offer high calorie snacks between meals and at bedtime.
Which of the following topics should the nurse include in medication teaching for a client with newly diagnosed persistent asthma?
Self-administration of inhaled corticosteroids
The nurse is interviewing a client with a new diagnosis of chronic obstructive pulmonary disease (COPD). Which of the following information will help most in confirming a diagnosis of chronic bronchitis?
The client complains about a productive cough every winter for 3 months.
The nurse is conducting an admission history for a client with possible asthma who has new-onset wheezing and shortness of breath. Which of the following information indicates a need for a change in therapy?
The client takes propranolol for hypertension.
After the nurse has finished teaching a client about pursed lip breathing, which of the following client actions indicate that more teaching is needed?
The client tenses the neck muscles while exhaling.
Which of the following findings by the nurse for a client with a nursing diagnosis of impaired gas exchange will be most useful in evaluating the effectiveness of treatment?
a. Pulse oximetry reading of 91%
b. Absence of wheezes or crackles
c. Decreased use of accessory muscles
d. Respiratory rate of 22 breaths/minute
Pulse oximetry reading of 91%
The nurse is teaching a client with chronic obstructive pulmonary disease (COPD) about exercise. Which of the following information should the nurse include?
"Use the bronchodilator before you start to exercise."
The nurse is evaluating the effectiveness of therapy for a client with cor pulmonale. Which of the following findings should the nurse assess for in the client?
After the nurse has completed diet teaching for a client with chronic obstructive pulmonary disease (COPD) who has a body mass index (BMI) of 20, which of the following client statements indicate that the teaching has been effective?
"I will have ice cream as a snack every day."
The nurse is caring for a client with chronic obstructive pulmonary disease (COPD) who is receiving oxygen. Which of the following actions is best for the nurse to implement to determine the appropriate oxygen flow rate?
Maintain the pulse oximetry level at 90% or greater.
Which of the following information should the nurse include in teaching a client with chronic obstructive pulmonary disease (COPD) who has a new prescription for home oxygen therapy?
Oxygen use can improve the client's prognosis and quality of life.
The nurse is caring for a client who is receiving 35% oxygen via a Venturi mask. To ensure the correct amount of oxygen delivery, it is most important that the nurse implement which of the following actions?
Keep the air entrainment ports clean and unobstructed.
Which of the following information should the nurse teach a client with COPD?
To have 5 or 6 small meals a day.
Which of the following actions should be included in the plan of care for a client with cystic fibrosis (CF) who is admitted to the hospital with increased dyspnea?
Perform chest physiotherapy every 4 hours.
The nurse is developing a teaching plan to help increase activity tolerance at home for a 70-year-old client with severe chronic obstructive pulmonary disease (COPD). Which of the following exercise goals should the nurse teach the client?
Walk for a total of 20 minutes daily.
Which of the following diagnostic tests should the nurse plan to discuss with a client who has progressively increasing dyspnea and is being evaluated for a possible diagnosis of chronic obstructive pulmonary disease (COPD)?
The nurse is caring for a client with severe chronic obstructive pulmonary disease (COPD) who tells the nurse, "I wish I were dead! I cannot do anything for myself anymore." Based on this information, which of the following nursing diagnoses is best?
Social isolation related to insufficient personal resources (increased physical dependence)
The nurse is admitting a client with chronic obstructive pulmonary disease (COPD) to the hospital. Which of the following positions should the nurse place the client in to improve gas exchange?
Sitting up at the bedside in a chair and leaning slightly forward
A 45-yr-old man with asthma is brought to the emergency department by automobile. He is short of breath and appears frightened. During the initial nursing assessment, which clinical manifestation might be present as an early manifestation during an exacerbation of asthma?
The nurse is assigned to care for a patient who has anxiety and an exacerbation of asthma. What is the primary reason for the nurse to carefully inspect the chest wall of this patient?
Evaluate the use of intercostal muscles.
Which position is most appropriate for the nurse to place a patient experiencing an asthma exacerbation?
A patient with an acute exacerbation of chronic obstructive pulmonary disease (COPD) needs to receive precise amounts of oxygen. Which equipment should the nurse prepare to use?
The physician has prescribed salmeterol (Serevent) for a patient with asthma. In reviewing the use of dry powder inhalers (DPIs) with the patient, what instructions should the nurse provide?
"Close lips tightly around the mouthpiece and breathe in deeply and quickly."
The nurse determines that a patient is experiencing common adverse effects from the inhaled corticosteroid beclomethasone after what occurs?
Oropharyngeal candidiasis and hoarseness
Which test result identifies that a patient with asthma is responding to treatment?
A decreased exhaled nitric oxide
The patient has an order for each of the following inhalers. Which one should the nurse offer to the patient at the onset of an asthma attack?
The nurse, who has administered a first dose of oral prednisone to a patient with asthma, writes on the care plan to begin monitoring for which patient parameters?
The nurse is assisting a patient to learn self-administration of beclomethasone, two puffs inhaled every 6 hours. What should the nurse explain as the best way to prevent oral infection while taking this medication?
Rinse the mouth with water after the second puff of medication.
The nurse is evaluating if a patient understands how to safely determine whether a metered-dose inhaler (MDI) is empty. The nurse interprets that the patient understands this important information to prevent medication underdosing when the patient describes which method to check the inhaler?
Keep track of the number of inhalations used.
When planning teaching for the patient with chronic obstructive pulmonary disease (COPD), the nurse understands that what causes the manifestations of the disease?
Hyperinflation of alveoli and destruction of alveolar walls
The nurse evaluates that nursing interventions to promote airway clearance in a patient admitted with chronic obstructive pulmonary disease (COPD) are successful based on which finding?
Effective and productive coughing
The nurse teaches pursed-lip breathing to a patient who is newly diagnosed with chronic obstructive pulmonary disease (COPD). The nurse reinforces that this technique will assist respiration by which mechanism?
Preventing bronchial collapse and air trapping in the lungs during exhalation
Nursing assessment findings of jugular venous distention and pedal edema would be indicative of what complication of chronic obstructive pulmonary disease (COPD)?
Fluid volume excess resulting from cor pulmonale
A patient has been receiving oxygen per nasal cannula while hospitalized for chronic obstructive pulmonary disease (COPD). The patient asks the nurse whether oxygen use will be needed at home. What is the most appropriate response by the nurse?
"You will not need oxygen until your oxygen saturation drops to 88% and you have symptoms of hypoxia."
Before discharge, the nurse discusses activity levels with a 61-yr-old patient with chronic obstructive pulmonary disease (COPD) and pneumonia. Which exercise goal is most appropriate once the patient is fully recovered from this episode of illness?
Walk for 20 min/day, keeping the pulse rate less than 130 beats/min.
The nurse is teaching a patient how to self-administer ipratropium via a metered-dose inhaler (MDI). Which instruction given by the nurse is most appropriate to help the patient learn the proper inhalation technique?
"Breathe out slowly before positioning the inhaler."
Which statement made by the patient with chronic obstructive pulmonary disease (COPD) indicates a need for further teaching regarding the use of an ipratropium inhaler?
"If my breathing gets worse, I should keep taking extra puffs of the inhaler until I can breathe more easily."
When teaching the patient with chronic obstructive pulmonary disease (COPD) about smoking cessation, what information should be included related to the effects of smoking on the lungs and the increased incidence of pulmonary infections?
Decreased alveolar macrophage function
The nurse teaches a 53-yr-old male patient with chronic obstructive pulmonary disease (COPD) how to administer fluticasone by metered-dose inhaler (MDI). Which statement by the patient to the nurse indicates correct understanding of the instructions?
"I will rinse my mouth each time after I use this inhaler."
The nurse is caring for a 48-yr-old male patient admitted for exacerbation of chronic obstructive pulmonary disease. The patient develops severe dyspnea at rest, with a change in respiratory rate from 26 breaths/min to 44 breaths/min. Which action by the nurse would be the most appropriate?
Teach the patient to use pursed-lip breathing.
A 68-yr-old patient with bronchiectasis has copious thick respiratory secretions. Which intervention should the nurse add to the plan of care for this patient?
Increase intake to at least 12 eight-ounce glasses of fluid every 24 hours.
Is inflammation of the lung
Occurs when gas accumulate in the pleural cavity and creates positive pressure that causes the lung on the affected side to collapse
The nurse is conducting an integumentary assessment of a black client who has darkly pigmented skin and a history of COPD. Which of the following locations should the nurse inspect for cyanosis?
Clients nail beds & Conjunctiva of the clients eye
Destruction of the alveoli
Presence of productive cough for 3 months in 2 successive years
Is characterized by chronic inflammation found in the airways, lung parenchyma (respiratory bronchioles and alveoli), and pulmonary blood vessels
A chronic intermittent cough, often the earliest symptom, usually occurs in the morning and may or may not be productive of small amounts of sticky mucus
The nurse is caring for a client with an acute exacerbation of chronic obstructive pulmonary disease (COPD) who needs to receive precise amounts of oxygen. Which of the following types of equipment should the nurse prepare to use?
The nurse evaluates that nursing interventions to promote airway clearance in a client admitted with chronic obstructive pulmonary disease (COPD) are successful based on which of the following findings?
Effective and Productive Coughing
Is a preventable and treatable disease state characterized by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases, primarily caused by cigarette smoking.
Chronic obstructive pulmonary disease (COPD)
The presence of chronic productive cough for 3 months in 2 successive years, is a useful epidemiological term but does not convey how airway limitation severely affects morbidity and mortality in patients with COPD.
Is hypertrophy of the right side of the heart, with or without heart failure, resulting from pulmonary hypertension, and is a late manifestation of COPD with poor prognosis
Is a technique that is used to prolong exhalation, prevent bronchiolar collapse and air trapping, and assist with dyspnea