1Exhale, seal the spacer, press once, inhale slowly for 3 to 5 seconds, and hold the breath near 10 seconds.✓ Correct answer
2Press four puffs into the spacer together, then take a rapid shallow breath and exhale immediately.
3Place the spacer beside the mouth, press once during exhalation, and breathe through the nose.
4Inhale rapidly before pressing the canister, remove the spacer, and repeat without a pause.
Explanation
Correct metered-dose inhaler technique includes exhaling first, forming a tight seal around the spacer mouthpiece, actuating one puff, inhaling slowly and deeply for about 3 to 5 seconds, and holding the breath for about 10 seconds. Multiple puffs should not be loaded into the chamber together. Poor timing, an open seal, nasal breathing, or immediate exhalation reduces medication delivery.
Clinical reasoning A spacer holds the aerosol briefly, reducing the coordination needed between actuation and inhalation. Slow inhalation and a breath hold improve deposition in the lower airways.
Decision rule For an MDI with spacer: prepare the device, exhale, seal, actuate one puff, inhale slowly and deeply, hold, then wait before a second prescribed puff.
Scenario A 9-year-old child is learning to use an albuterol metered-dose inhaler with a spacer for acute asthma symptoms.
Spacer — A holding chamber attached to a metered-dose inhaler that improves aerosol delivery and coordination.
Metered-dose inhaler — A device that releases a measured aerosol dose of medication with each actuation.
Inhaler order — When prescribed both: bronchodilator FIRST, then corticosteroid; rinse mouth after corticosteroid.