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FOR SCHOOL NURSES
✦ The metered-dose-inhaler, or MDI medication that is used
in the school set ing is a short-acting bronchodilator. Below
are some of the ones currently used.
✦ These are the medications which a student with signed
permission from a healthcare provider would be al owed
✦ The indications for use of these medications are:
1. To relieve symptoms of bronchospasm. This could present as cough, wheezing, shortness-of-breath,
or a feeling of tightness in the chest or throat.
2. To prevent exercise-induced bronchospasm. If ordered by the childʼs healthcare provider on the Asthma
Treatment Plan, the bronchodilator should be given 15 to 30 minutes before exercise.
✦ Al of the MDI devices require priming according to the manufacturerʼs instructions in order for the proper dose
of medication to be delivered. Priming must be performed before using the inhaler for the first time.
is a quick reference chart for when to re-prime the bronchodilator MDIs.
Prime if NOT used
within the last:
• Use test-fire slide to release priming sprays
• Discard after 200 sprays, even if canister not empty
Consult the childʼs Asthma Treatment Plan to know when to administer these medications.
As a general rule-of-thumb, if a child needs to take a short-acting bronchodilator more
than two times in one week for relief of symptoms, their asthma may be out of control.
The child should be reevaluated by their healthcare provider.
MORE KEY FACTS ABOUT MDIs
✦ Al MDIs must be stored at normal room temperature. Failure to use the products
within the specified temperature range may result in improper dosage of medication
✦ Never use the canister from one medication in the actuator, or plastic mouthpiece of another medication.
✦ Never get the metal canister which contains the medication wet.
✦ Build-up of medication around the tiny spray hole in the plastic actuator can prevent the proper dose of medication
from being administered. Al manufacturers recommend cleaning the plastic actuator at least once a week.
✦ The action of these medications should last for 4 to 6 hours. Fol ow the Asthma Treatment Plan and do not exceed
✦ Possible side-ef ects include: shakiness, nervousness, heart palpitations, chest pain , worsening of wheezing, throat
irritation, changes in blood pressure, vertigo, cough, and musculoskeletal pain.
✦ If the MDI does not have a dose counter, ask the parent for a new inhaler so you can keep track of the number
of doses which have been used. Donʼt forget to count the priming doses, too. Replace the MDI after the labeled
number of actuations have been used.
✦ When you receive the MDI from parent, check the expiration date on the canister.
BASIC STEPS FOR TAKING A MDI
11. Remove the cap from the inhaler and inspect the mouthpiece for any foreign objects.
12. Make sure that the metal medication canister is properly seated in the plastic actuator.
13. Prime the inhaler if necessary.
14. If a spacer is to be used, remove the cap from the spacer and inspect for foreign objects or damage to the spacer.
15. Always hold the MDI upright (see picture) with the metal canister at the top.
16. Shake the MDI wel before each spray.
17. Breathe out ful y away from the inhaler.
18. Put the inhaler or spacer into your mouth and spray only one puf as you start a long, slow inhalation.
19. Hold your breath as long as possible, up to 10 seconds, before exhaling.
10. Wait at least one minute between puf s.
The Pediatric/Adult Asthma Coalition of New Jersey, sponsored by the American Lung Association in New Jersey, and this publication are supported by a grant from the New
Jersey Department of Health and Senior Services (NJDHSS), with funds provided by the U.S. Centers for Disease Control and Prevention (USCDCP) under Cooperative
Agreement FHS-2011-Asthma-Ful -0003. Its contents are solely the responsibility of the authors and do not necessarily represent the of icial views of the NJDHSS or the USCDCP.
Although this document has been funded whol y or in part by the United States Environmental Protection Agency under Agreement XA97250908-3 to the American Lung
Association in New Jersey, it has not gone through the Agencyʼs publications review process and therefore, may not necessarily reflect the views of the Agency and no of icial
endorsement should be inferred. Information in this publication is not intended to diagnose health problems or take the place of medical advice. For asthma or any medical
condition, seek medical advice from your childʼs or your health care professional.
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Die Neuformulierung des Andenkens seit der Empfindsamkeit in: Der Souvenir. Erinnerung in Dingen von der Reliquie zum Andenken, hg. v. Museum für Angewandte Kunst Frankfurt. Köln: Wienand 2006, S. 156-187. Mit der Herausbildung einer neuen Gefühlskultur ab Mitte des 18. Jahrhunderts ist eine grundlegende Zäsur in der Geschichte des Souvenirs, im deutschen Sprachgebrauch der Zeit: des Ande