Asthma Management Handbook
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Table. Using pressurised metered-dose inhalers in acute asthma

Administration of salbutamol by health professionals for a patient with acute asthma

  1. Use a salbutamol pressurised metered-dose inhaler (100 microg/actuation) with a spacer that has already been prepared (see note).
  2. Shake inhaler and insert upright into spacer.
  3. Place mouthpiece between the person’s teeth and ask them to seal lips firmly around mouthpiece.
  4. Fire one puff into the spacer.
  5. Tell person to take 4 breaths in and out of the spacer.
  6. Remove the spacer from mouth. Shake the inhaler after each puff before actuating again. (This can be done without detaching the pressurised metered-dose inhaler from the spacer.)


The process is repeated until the total dose is given. Different doses are recommended for patients and carers giving asthma first aid in the community.

New plastic spacers should be washed with detergent to remove electrostatic charge (and labelled), so they are ready for use when needed. In an emergency situation, if a pre-treated spacer is not available, prime the spacer before use by firing at least 10 puffs of salbutamol into the spacer. (This is an arbitrary number of actuations in the absence of evidence that would enable a precise guideline.)

Priming or washing spacers to reduce electrostatic charge before using for the first time is only necessary for standard plastic spacers. Treatment to reduce electrostatic charge is not necessary for polyurethane/antistatic polymer spacers (e.g. Able A2A, AeroChamber Plus, La Petite E-Chamber, La Grande E-Chamber) or disposable cardboard spacers (e.g. DispozABLE, LiteAire).

For small children who cannot form a tight seal with their lips around the spacer mouthpiece, attach a well-fitted mask to the spacer.

Last reviewed version 2.0

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