Metered Dose Inhalers

There are 3 components to a MDI: the pressurized canister, the metering valve and stem, and a mouthpiece.  Chlorofluorocarbons (CFCs) were banned from use following the ratification of the Montreal protocol; therefore, current MDIs use a hydrofluoroalkane (HFA) propellant.  The canister houses the drug suspended in a mixture of propellants, preservatives, surfactants, flavoring, and dispersal agents.  HFA MDIs more efficiently deliver the dose of medication to the

lungs compared to CFC MDIs.  Lung deposition can vary between 10-40% of the dose based upon technique, with much of the drug depositing in the oropharynx.,  Examples of MDIs are Flovent© HFA, Atrovent© HFA, and Ventolin© HFA.

MDIs should be cleaned once a week to prevent the buildup of medication around the mouthpiece.  The following steps are recommended for cleaning.

  • Remove the mouthpiece cover and canister.  Do not get the canister wet.
  • Clean the mouthpiece with warm tap water for 30-60 seconds.
  • Completely dry the mouthpiece; it is recommended to let it dry overnight
  • Replace the canister, and activate MDI once away from the face.
  • Replace the mouthpiece cover.

It is important to know when the device is running low on medication.  Some devices have counters, but if the device does not, it is recommended that the patient keep a log of uses.  Advantages of the MDI are ease of operation, suitability for all ages, multi-dosing, lightweight, and portability.  Disadvantages are difficult coordination between actuation and inhalation, deposition of drug in the oropharynx, and risk of improper use.

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