Your Guide to Using Inhalers and Spacer Devices

There are two main types of inhalers, relievers and preventers:

• reliever medication (use when needed) – usually a blue coloured inhaler. They relieve the symptoms of cough and wheeze by relaxing the tight muscles around the airways allowing the airway to open wider, making it easier to breathe.
• preventer medication (need to use regularly) – usually brown, beige, orange or purple coloured inhalers. These are steroid inhalers and help to prevent asthma symptoms by reducing the amount of swelling and inflammation in the airway, which stops them from being so sensitive. These are usually taken twice a day and should not be stopped without medical advice. Remind your child to clean their teeth or rinse their mouth with water after using the preventer inhaler or, if using a mask with the spacer, remember to wipe your child’s face with a damp flannel.
  This will prevent your child from having a sore mouth.

1. Remove the cap from the inhaler and shake the inhaler.
2. Gently press the inhaler into the inhaler holder of the Babyhaler.
3. Place the mask gently and securely over your baby’s nose and mouth.
4. Hold the Babyhaler at an angle that is comfortable for you and your baby.
5. Keep the mask over the mouth and nose until your baby has taken at least 5 – 10 breaths (usually about 15 seconds).
   Count the breaths by watching the valves move with each breath.
6. To give another dose, wait at least 30 seconds to 1 minute then shake the inhaler and repeat steps 2-5.

1. Remove the cap from the inhaler, shake the inhaler and insert it into the back of the spacer.
2. Place the mask of the spacer over your child’s mouth and nose, ensuring there is a good seal.
3. Tilt the spacer to a 45° angle.
4. Once breathing pattern is established, press the inhaler canister once to release one puff of medicine, keeping the spacer in the same position as your child continues to breathe slowly in and out five more times.
   Note: if your child is breathing fast, the breaths will be shallow. In this case, aim for 10 breaths to each puff of medicine.
5. To give another dose, wait at least 30 seconds to 1 minute then repeat steps 1-4.

1. Remove the cap from the inhaler, shake the inhaler and insert it into the back of the spacer.
2. Put the mouthpiece in the mouth, ensuring there is a good seal of your child’s lips around the mouthpiece.
3. Encourage your child to breathe in and out slowly and gently.
4. Once the breathing pattern is established, press the inhaler canister once to release one puff of medicine, keeping it in the same position as your child continues to breathe slowly in and out five more times.
   Note: if your child is breathing fast, the breaths will be shallow. In this case, aim for 10 breaths to each puff of medicine.
5. If the spacer is held horizontally the valve on the spacer should click. If your child is not moving the valve tilt the spacer to a 45° angle so that the valve goes into the open position. This will ensure your child receives the dose of medicine.
6. To give another dose, wait at least 30 seconds to 1 minute then repeat steps 1-4.

• Only put one puff of medicine into the spacer at a time.
  If more than one puff is put into the spacer, the droplets of spray stick together and coat the sides of the spacer, so your child receives less of the medication.
• Spacers should be washed once a month in warm soapy water and allowed to drip dry. Wipe the mouth piece only to ensure it is free of detergent. This helps to prevent the medication sticking to the sides of the spacer.

1. Remove the caps from the inhaler and spacer. Shake the inhaler and insert it into the back of the spacer.
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2. Place the mask of the spacer over your child’s mouth and nose, ensuring there is a good seal.
3. Encourage your child to breathe in and out slowly and gently.
4. Once the breathing pattern is established, press the inhaler canister once to release one puff of medicine, keeping it in the same position as your child continues to breathe slowly in and out five more times.
5. To give another dose, wait at least 30 seconds to 1 minute then repeat steps 1-4.

1. Hold the outer casing of the accuhaler in one hand whilst pushing the thumb grip away with the thumb of the other hand, until a click is heard.
2. Hold the accuhaler with the mouthpiece towards you and slide the lever away until it clicks. This makes the dose ready for inhalation and moves the dose counter on.
3. Your child should breathe out gently. Holding the device horizontally, put the mouthpiece in your child’s mouth and they should suck in quickly and deeply.
4. Remove the accuhaler from your child’s mouth and they should hold their breath for 10 seconds or for as long as it is comfortable.
5. To close, slide the thumb grip back towards you until it clicks.
6. For a second dose, repeat steps 1-5. The counter on top of the accuhaler tells you how many doses are left. Numbers 5-0 will appear in red, to warn you when there are only a few doses left.

1. Unscrew and lift off the cover. Hold the turbohaler upright and twist the grip forwards and backwards as far as it will go. You should hear a click.
2. Your child should breathe out gently, put the mouthpiece between our child’s lips and have them breathe in as deeply as possible, then hold their breath for 10 seconds. Even when a full dose is taken there may be no taste.
3. Remove the turbohaler from your child’s mouth and they should breathe out slowly.
4. Replace the cover. To give another dose, repeat steps 1-3.
   When a red line appears at the top window of the device there are approximately 20 doses left. Some turbohalers have a dose counter to tell you how many doses are left in the inhaler.

1. Shake the inhaler, hold it upright and open the cap.
2. Your child should breathe out gently. Hold the inhaler upright, put the mouthpiece in your child’s mouth and close their lips and teeth around it. Do not block the air holes on top.
3. Your child should breathe in steadily through the mouthpiece and not stop breathing in when the inhaler ‘puffs’ but continue taking a deep breath, then hold their breath for about 10 seconds or as long as is comfortable.
   Remove the inhaler from your child’s mouth.
4. After use, hold the inhaler upright and immediately close the cap. For a second dose, wait approximately 30 seconds then repeat steps 1-3. Only use the device for the number of doses on the label, then start a new inhaler.

1. Remove the mouthpiece cover. Hold the autohaler upright and push the lever right up.
   Shake the inhaler. If this is a new inhaler or you have not used it for two weeks or more, you must test it is working by releasing two puffs into the air.
2. Your child should breathe out gently. Hold the inhaler upright, put the mouthpiece into your child’s mouth and close their lips and teeth around it. (The air holes at the bottom must not be covered by your hand).
3. Your child should breathe in steadily through the mouthpiece and not stop breathing when the inhaler ‘clicks’ but continue taking a deep breath, then hold their breath for about 10 seconds or as long as is comfortable.
   Remove the inhaler from your child’s mouth.
4. Lower grey lever.
5. To give another dose, wait approximately 30 seconds then repeat steps 1-4. Only use the device for the number of doses on the label, then start a new inhaler.

1. Remove the mouthpiece and shake the inhaler. Hold the clickhaler upright.
2. With your thumb on the base and a finger on the coloured button, press the dosing button firmly once until it clicks, then release.
3. Your child should breathe out and put the mouthpiece between their lips and teeth, sealing their lips around the mouthpiece.
4. Your child should breathe in steadily and deeply. Remove it from your child’s mouth and hold their breath for about 10 seconds or for as long as is comfortable, then breathe out slowly.
5. To give another dose, keep the clickhaler upright and repeat steps 1-4.
6. The dose counter window on the back of the clickhaler tells you how many doses are left in the device. A red warning appears when there are 10 doses left. When the clickhaler is empty the device locks and can no longer be used. It should then be discarded.

1. Remove the cap and shake the inhaler.
2. Breathe out gently.
3. Put the mouthpiece in your child’s mouth They should begin to breathe in deeply and slowly. Press the canister down while they continue to inhale steadily and deeply.
4. Your child should hold their breath for 10 seconds or for as long as it is comfortable.
5. To give another dose, wait approximately 30 seconds then repeat steps 1-4. Only use the device for the number of doses on the label, then start a new inhaler.
   We would not recommend using the metered dose inhaler this way for any child under 12 years of age, when other inhalers are preferable.

If you have any further questions, please contact the Children’s Asthma Nurse on 01206 742125.