Table 1.

Inhaler technique steps for a Metered Dose Inhaler (MDI) with and without a spacer at baseline

Step	MDI with spacer	MDI without a spacer
1	Remove cap from inhaler	Remove cap from inhaler
2	Attach inhaler mouthpiece into holding chamber	Shake inhaler 4-6 times
3	Shake inhaler 4-6 times	Exhale normally
4	Exhale normally	Tilt head back slightly, place mouthpiece between lips or 1-2 inches in front of a wide open mouth
5	Tilt head back slightly, place holding chamber mouthpiece between lips, holding inhaler upright	Begin a slow, deep breath
6	Press inhaler canister once to place dose in holding chamber	Press inhaler canister once at beginning of breath
7	Begin a slow, deep inhalation immediately after placing dose in holding chamber (3-4 seconds)	Continue to inhale for 3-4 seconds
8	Hold breath for 10 seconds	Hold breath for 10 seconds

Note: MDI= metered dose inhaler