Table 2. Percentages of mistakes per step, total percentages of patients making incorrect inhalation techniques per controller device.

Essential steps	pMDI (n=44)	pMDI with spacer (n=60)
Shake inhaler thoroughly	22.7	8.3
Remove the cap and keep inhaler in upright position	11.4	na
Remove cap and insert inhaler correctly into spacer	na	1.7
Breathe out gently to residual volume	50.0	53.3
Close lips on inhaler or spacer mouthpiece	0.0	0.0
Press the canister at beginning of inhalation	40.9	na
Hold spacer level and press down firmly on canister once	na	21.2
Inhale slowly and deeply	27.3	43.3
Hold breath for at least 10 seconds	27.3	48.3
Breath in and out through mouthpiece at least three times	na	20.0
Patients performing incorrect inhalation techniques	33 (75.0%)	49 (81.7%)
Patients performing incorrect flow (<30 or >60 L/min)	28 (63.6%)	33 (55.0%)
Overall (incorrect technique and flow)	42 (95.5%)	54 (90.0%)

pMDI, pressurized metered-dose inhaler; na, not applicable to the device.