How To Clean Inhalers

Is It Necessary? How Often?

Dear Dr. Mahler:

I recently read that I should clean my inhalers to make sure that they work correctly and to prevent infections. However, I can’t find any information that describes how to do this. I use Symbicort inhaler and Spiriva powder every day and ProAir as my rescue inhaler. What do you recommend?

Gerard from San Juan, Puerto Rico

Dear Gerard:

You ask an important question about keeping inhaler devices clean and working properly. Unfortunately, this topic – cleaning inhalers – has not received a lot of attention.

As I am sure that others with COPD have the same question or concern as you do, here is information for cleaning inhalers as well as nebulizers.

pressurized Metered-Dose Inhaler (abbreviated pMDI)

**pMDI**

Diagram of pressurized metered-dose inhaler

When you press down on the top of the chamber, the aerosol spray comes out of the metering chamber and enters the nozzle (see above). There is concern that the spray might accumulate over time and clog the nozzle. Cleaning the actuator with running water and air drying is recommended periodically to reduce this possibility.

Dry-Powder Inhaler (abbreviated DPI)

A clean, dry cloth should be used to wipe away any powder from the mouthpiece. This should minimize any contamination with bacterial or fungus. This should be done periodically.

Slow Mist Inhaler (abbreviated SMI)

All that is required with the slow mist inhaler is to clean the mouthpiece with a damp cloth. It is recommended that cleaning be performed periodically.

Nebulizer

The main source of nebulizer contamination is the patient. People of all ages tend to drool into the mouthpiece which explains why bacteria are frequently found in the reservoir (cup) after use.

Any liquid that remains in the cup after you have finished inhaling leaves a wet environment with potential for growth of bacteria. This has led to the recommendation that the nebulizer cup and mouthpiece be rinsed, washed, and air dried after each use.

Here are specific recommendations:

Detach the medicine cup and mouthpiece from the tubing.
Wash the medicine cup and mouthpiece with warm soapy water and rinse them with water.
Place the equipment on a clean towel to fully air dry. Make sure to do this after each treatment and daily.
Don’t wash the tubing. If it gets wet, replace the tubing. Also, don’t put any parts of the nebulizer into a dishwasher to clean it because the heat can warp the plastic. Tubing should be changed periodically, usually every two weeks.

Here is a way to disinfect the mouthpiece and cup every other day. Mix a solution of 1 part distilled white vinegar and 3 parts warm tap water in a clean bowl. Soak the nebulizer parts (except the tubing and mask) for 60 minutes, then rinse thoroughly and air dry.

Please note, the advice provided is not a substitute for asking your health care professional about your specific situation.

Sincerely,

Donald A. Mahler, M.D.