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Table 1 ATS guidelines on correct MDI use

From: Effectiveness of one-on-one coaching in improving pressurized metered dose inhaler (pMDI) technique among COPD patients: a prospective clinical study

1 Put the metal canister into the “boot” making certain it is seated correctly
2 Shake the inhaler several times. This mixes the propellant and medicine
3 Remove the cap off from the mouthpiece
4 Breathe out to the end of a normal breath
5 Hold the inhaler in its upright position (with the mouthpiece at the bottom)
6 Put the mouthpiece in your mouth, past your teeth and above your tongue. Close your lips around the mouthpiece so that the medication does not go in your eyes
7 While breathing in slowly and deeply through your mouth, fully press down once on the top of the metal canister of your inhaler
8 Hold your breath for 5 to 10 s
9 Breathe out slowly
10 If you take more than one spray, wait 15 to 30 s (or as directed in the package insert) before taking the next puff. Then repeat steps 3–9
11 Replace the cap on the mouthpiece after you are finished
12 If you are inhaling a steroid, rinse your mouth out with water, swish, gargle and spit