Table 1.

Recommended Checklist of Metered-Dose Inhaler (MDI).3, 4, 8

	Step	Score
1	Shake the inhaler well.a
2	Remove the dust cap.a
3	Exhale slowly through pursed lips.
4	If using the “closed-mouth” technique, hold the inhaler upright and place the mouthpiece between your lips. Be careful not to block the opening with your tongue or teeth.
	If using the “open-mouth” technique, open your mouth wide and hold the inhaler upright 1–2 inches from your mouth, making sure the inhaler is properly aimed.
5	Press down on the inhaler once as you start a slow, deep inhalation.a
6	Continue to inhale slowly and deeply through your mouth. Try to inhale for at least 5 s.
7	Hold your breath for 10 s (use your fingers to count to 10 slowly). If 10 s makes you feel uncomfortable, try to hold your breath for at least 4 s.
8	Exhale slowly.
9	Wait at least 30–60 s before inhaling the next puff of medicine.

^aCritical steps.