1. Shake the MDI
[Sometimes the propellant and medication separate into different layers over time. Shaking the inhaler insures a proper mix. Otherwise, one may receive more propellant than medicine.]
2. Insert the MDI into the spacer
3. Fully exhale
4. Put mouthpiece of spacer into your mouth.
5. Pump the inhaler into the spacer
6. Then begin inhalation.
The inhalation should be slow and soft, ideally lasting 5 seconds.
Most spacers will whistle if you inhale too hard. Slow down if the spacer whistles.
[Inhaling fast and hard results in LESS delivery of medication to the lungs - not more. Since MDI's are pressurized, hard and fast inhalations result in aerosol hitting the back of the throat with more force. This scatters the aerosol in various directions for about 1 second. Then when the particles are ready to continue their journey into the lungs, the fast inhalation has ended. Thus, the aerosol remains in the throat and never makes it into the lungs.]
7. Hold your breath for 10 seconds.
[During these 10 seconds, the aerosol spreads to the edge of the lungs. If one does not do this, the aerosol stays only in the central part of the lung. These 10 seconds effectively double or triple the dose.]