Using your metered dose inhaler (MDI) properly will allow you to get the most benefit from your medication.

Follow these steps when using your MDI:

1. Wash your hands thoroughly with soap and water. Dry them with a clean towel.
2. Shake the inhaler five or six times immediately before each inhalation.
3. Remove the cap from the mouthpiece. If the cap was off, check the mouthpiece for dirt and debris.
4. Attach a tube spacer to the mouthpiece of your inhaler if your inhaler allows for that. Using a tube spacer helps get more medication deep into your lungs instead of remaining in your mouth.
5. With one hand, hold the tube spacer, and hold the inhaler with your other hand. The end of the medication container should be facing upward and the mouthpiece facing you. Place your index finger on top of the medication container and your thumb on the bottom of the plastic case.
6. Hold your head upright and sit up straight or stand. Breathe out normally, not forcefully, until your lungs feel empty.
7. Close your mouth around the open end of the tube spacer. Make sure your tongue or teeth aren't blocking the opening. If you don't have a tube spacer, place the mouthpiece of the inhaler about two inches in front of your open mouth.
8. As you push down with your index finger on the top of the inhaler, breathe in slowly and deeply for five to seven seconds or as long as comfortable. This process mixes the medication with the incoming air and pulls it into your lungs slowly.
9. Remove the tube spacer from your mouth and close your lips. Hold your breath for as long as comfortable or up to 10 seconds to help the medication settle in your airways.
10. Breathe out slowly. Wait at least one minute before taking another puff.
11. Repeat step 2 and then steps 5 through 10 for each puff.

• When using the inhaler the first time, test spray it into the air as recommended in the manufacturer's instructions. If the inhaler hasn't been used for several days, test spray it before use.
• You can buy a tube spacer without a prescription at a pharmacy or medical supply store. Several types of tube spacers are available. Some include a holding chamber that requires a different breathing technique. If your health care provider or pharmacist recommends another type of tube spacer or chamber device, check the manufacturer's instructions or ask your health care provider or pharmacist for instructions. The valved holding chamber can be used with all MDIs.
• After using an inhaler that contains a corticosteroid medication, rinse your mouth with water and spit it out. Gargle or brush your teeth. This may help prevent irritation in your mouth and throat.
• In a cold environment, carry the MDI close to your body. If your inhaler is cold, warm it by rolling it between your hands before use. Warming your inhaler to body temperature converts the medication into smaller particles, allowing you to inhale more medication for better distribution throughout your lungs.
• Always keep the protective cap on the inhaler when not in use.
• Note the expiration date on the medication canister or box. If you don't use the MDI by this date, discard the inhaler.
• Store medication at room temperature, away from heat or direct sunlight. Do not keep medication in a car.

Clean the inhaler and tube spacer twice a week, or more frequently if used daily.

Follow these steps:

1. Remove the medication canister.
2. Wash the plastic case and cap with soapy water. Most tube spacers also can be washed in soapy water. Check the manufacturer's instructions for cleaning information for your tube spacer. (Do not wash the medication canister.)
3. Rinse the pieces with warm, running water.
4. Let the pieces air-dry.
5. After the case and cap are dry, insert the medication canister into the plastic case with a gentle, twisting motion.

Make sure you always have enough metered dose inhaler medication. Refill the prescription seven to 10 days before it is expected to run out.

If your MDI does not have a counter, you can determine how many days it will last by dividing the number of puffs in the MDI (this number usually is printed on the container or box) by the number of puffs you use each day. Count each test spray as a puff.

For example: Your MDI contains 50 puffs. Your health care provider prescribed two puffs per day.

50 puffs in the MDI

2 puffs per day = 25 days

If you use your MDI only as needed and it does not have a counter, follow these steps to determine how long it should last:

1. On the date you begin using a new inhaler, write on a calendar the number of puffs in your inhaler.
2. Put a small piece of masking tape on the plastic part of your inhaler. Each time you use your inhaler, make a mark for each puff on the piece of tape. Count test sprays, too.
3. Once a week, remove the tape. Add up the marks and then subtract the total from the number of puffs you listed on the calendar. Write the remaining number of puffs on the calendar.
4. Put a new piece of tape on the inhaler and repeat this process each week.
5. Refill your prescription seven to 10 days before you think your MDI will run out based on the average number of puffs you use weekly.

When you reach the date you determined the MDI would run out, you may continue to hear or feel something in the container, but the medication is gone.

Different kinds of medications come in metered dose inhalers. Your health care provider might prescribe a combination of these medications. Discuss the side effects with your health care provider.