2.25: Inhaler Medication Treatment
Category: UWHC Clinical Policy
Policy Number: 2.25
Effective Date: June 1, 2015
Section: Respiratory Care Services
Inhaler therapy is provided with a medication delivery device to treat the lungs locally while minimizing
absorption and distribution throughout the body.
II. CONTRAINDICATIONS: see Micromedic for agent specific contraindications
A. All patients will be assessed by a pharmacist or a respiratory care practitioner (RCP) to determine
if the appropriate indications for therapy are present and to determine the appropriate mode of
B. Therapy will be provided in accordance with a provider’s order.
C. All inhalers & boxes are labeled with a patient’s label.
D. Preferred method of delivery for metered dose inhaler (MDI) and hydrofluoroalkanes (HFA) are with
E. American Family Children’s Hospital (AFCH) recommends inhalers on all pediatric patients.
1. Labeled inhalers contained in their box or plastic bag are to be stored in the appropriate
pharmacy cassette drawer after use.
2. If the patient is in isolation, cavi-wipe the labeled inhaler and place it back in the plastic bag
inside the appropriate pharmacy cassette drawer.
F. A dosage check-off card is used on all non-counter devices.
G. A provider’s order is required for self-administering medications or to store medications at
A. Inhaler with spacer device if applicable.
B. Non-ventilated patient with an artificial airway
2. 15mm and 22mm adapter
3. Manual resuscitator with oxygen connecting tubing
C. Mechanical Ventilation
1. Main flow bacteria filters
2. Mini spacer
A. Review and acknowledge the provider's order.
B. Review the patient's chart.
C. Obtain the appropriate equipment.
D. Scan out the medications using the medication bar code. If unable to scan, sign out the medication in
the Medication Administration Record (MAR).
E. Scan the patient’s wrist band.
F. Patients discharged from the ED will need their inhaler relabeled. See related link.
G. All patients will receive the appropriate Health Facts for You (HFFY).
H. Introduce yourself to the patient and family. Explain the reason for the procedure.
I. Administration of inhaler therapy includes instructing patients on proper technique and evaluating their
ability to reliably use the device. A placebo inhaler may be utilized for patient instruction.
1. The patient should be seated as upright as possible to maximize inspiration.
2. The patient should have head tilted back slightly to straighten their airway.
3. The patient should breathe out completely with their mouth open.
4. The patient should close their mouth around the mouth piece and breathe in as deeply as they
can through their mouth, rapidly or slowly, depending on the specific device.
5. The patient should hold their breath for 5 - 10 seconds, followed by a slow exhalation.
6. Small children and others unable to do a breath hold will have monitoring of the movement
from the one-way valve and /or patient’s chest to ensure patient has inspired 5-10 breaths.
J. Proper steps will be taken after the delivery of a steroid medication.
1. Rinsing of the mouth with liquid and then spitting it out or swallowing.
2. Wiping the face off with a wet washcloth.
K. Mechanical Ventilation
1. Use a spacer on the inspiratory side of the wye.
2. A Main Flow bacteria filter is needed on the expiratory side of the circuit.
3. Actuate the inhaler at the beginning of inspiration.
4. Keep the main flow bacteria filter in line for two minutes after delivery.
5. Utilize the appropriate color-coded dosage check-off card, as the counter is inactive.
L. Non-ventilated patient with an Artificial Airway.
1. Aerotrach device should be used with patients who are able to take a deep breath.
2. A manual resuscitator and mini spacer should be used with infants or patients who are unable
to take a deep breath.
M. All pressurized MDIs are to be marked “dispose,” and returned to Pharmacy for disposal.
A. AARC Clinical Practice Guidelines
1. Delivery of Aerosols to the Upper Airway
2. Selection of an Aerosol Delivery Device
B. Respiratory Care
1. Policy # 1.40, Cleaning and Monitoring of Patient Care Equipment
2. Related links
a. Inhaler Re-label in ED
b. Inhaled Respiratory Medications
C. On line Micromedic
D. Health Facts for You
1. #6924 Meter Dose Inhalers and Chambers for Respiratory Therapy
2. #6951 Meter Dose Inhaler - Spanish
3. #5740 Diskus
4. #6658 Flexhaler
5. #6135 Spiriva HandiHaler
6. #6841 Inhaler with a spacer-Respiratory Therapy
7. #6656 Asthma Controller Medicine Inhaled Corticosteroid and Long Acting Bronchodilator
8. #6660 Asthma Rescue Medicine
9. #6657 Asthma controller Medicine Inhaled Corticosteroids
10. #6662 Asthma Controller Medicine Leukotriene Modifiers
Signed By: Director and Medical Director of Respiratory Care:
Original copy of this Policy & Procedure is available in the Respiratory Care Office [E5/489].