TABLE 1.

Metered Dose Inhaler Device Technique

	Percent (N)
Steps used by all children who stated they used a metered dose inhaler (N = 270)
Remove cap from inhaler	97.3 (256)
Shake inhaler 4–6 times	44.4 (116)
Exhale normally	36.2 (93)
Tilt head back slightly, with inhaler upright, place mouthpiece between lips or 1–2 inches in front of a wide open mouth	83.9 (218)
Between a slow deep breath	81.7 (214)
Press inhaler canister once at beginning of breath	84.0 (220)
Continue to inhale for 3–4 s	63.9 (166)
Hold breath for 10 s	32.6 (85)
Wait at least 30 s and repeat steps 2–8 if using another puffa	27.2 (69)
Children who performed all steps correctly	8.1 (22)
Steps used by children who stated they usually used a spacer who demonstrated spacer use (N = 69) Remove cap from inhaler	94.1 (64)
Attach inhaler into holding chamber	95.5 (64)
Shake inhaler 4–6 times	42.4 (28)
Exhale normally	52.2 (35)
Tilt head back slightly, place holding chamber mouthpiece between lips, holding inhaler upright	80.6 (54)
Press inhaler canister once to place dose in holding chamber	91.0 (61)
Begin a slow deep inhalation immediately after placing dose in holding chamber (3–4 s)	83.6 (56)
Hold breath for 10 s	46.3 (31)
Wait at least 30 s and repeat steps above if using another puffa	40.3 (27)
Children who performed all steps correctly	20.3 (14)

^aThis step was not included in the calculation of children who performed all steps correctly because some children may or may not have been prescribed a second dose.