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Use of MDI's directly into the mouth

Hello everyone,

I have a particular issue that really gets me on my soap box & it is the use of MDI's directly into the mouth.

There is reseach that says that a very small amount (as little as 4% some say) reaches the lungs even if the patient is adult, not short of breath & well co-ordinated.

There are other devices that deliver much more & therefore will enable the patient to have better controll.

So why do I see information leaflets from many organisations, TV programmes etc all depicting a person doing just this?

Yesterday & last week, I saw a patien's his grandfather & a member of a charity group I sit on, who both had COPD doing exactly that.

Both said they did have spacers at home but they could not take them out with them & both said that they did not know there was anything else.

With the cost of MDI's now not much different to other aerosol hand devices & with evidence that they will receive more that the say 4% why is this happening?

I would love a good discussion about this.


4 Replies

Hi Ann,

I agree with you 100%. It is also very frustrating to myself when I see patients in clinic taking their MDI straight. The vast majority have poor technique and as you say, with the cost not being all that different why are patients continued to be prescribed just an MDI?!

Can I ask what your preffered device is - either dry powder, MDI + spacer or breath actuated?



Hello Gavin,

Thank the Lord I was beginning to think I was weird.

I dont have a preferred one but we assess all our new patient or patient who reach the age of 7 for another type. We ask them about their hobbies or pass time so we can advice them on the best one. An eg would be are they swimmers if yes maybe power devices aren't the best, are they footballers, in which case power could be kept by the touch line for when they need it, are they runners, if so then autohalers may be to clumsy to do when they are running.

However, we give them just two to sample in clinic then see which they do best & what they like. We get one issued but they are told to give it a good try until we next see them in clinic & if they haven't got on with it we will change it to the other or reassess.

How do we go about raising this issue? I ru a teaching day every 3 month or so for acute and also primary nurses & we are involved in GP training that our Trust run so we do highlight this quite stronly.

But every day I see picture of this poor practice. Last week on a pharmacy information leaflet for asthma even on sites like this.




I approach this from a paediatric perspective. All our children are given an MDI+spacer from secondary care but the amount of kids who are advised to stop using their spacer out in GP land baffles me. Where do they get these ideas from? The amount of time I spend re-educating parents and their children on spacer use!

For my older patients who have issues carting their spacer around with them (usually teenagers) we often offer them a dry powder device (Accuhaler) or a breath actuated device to take with them when they are out and about, the decision on device type is made by the patient.



Hi Richard,

Yes we do the same all our patient by the time they are 7 are assessed for a HHD. If they are not ready we just keep trying each time they come to clinic as we assess them for their inhaler technique every clinic. We also tell them to tell the GP that it is the one they like & enter it into the letter to say this.

They are all told to keep a LVS & MDI for the bad days but often we are told the GP say they dont need both so wont prescribe one or the other. It is an on going battle when there are other devices some not expensive at all that deliver more etc etc but then I am obviously preaching to the converted here Richard. I just wish adverts on this sort of site would not show it as it is not best practice.

keep the faith




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