In delivering a dose via a metered-dose inhaler with spacer, which step follows delivering one puff into the spacer?

• A. Exhale completely
• B. Place lips around mouthpiece
• C. Take a slow deep breath and hold it for 10 seconds
• D. Rinse mouth with water

Answer: (C)

When using a metered-dose inhaler with a spacer, the goal is to get as much medication into the lungs as possible. After you release a puff into the spacer, you want a slow, deep inhalation to draw the drug deep into the airways, followed by a short breath-hold. Holding the breath for about 10 seconds lets the medication deposit in the bronchial walls rather than bouncing back out with the exhale, which increases effectiveness. Rinsing the mouth is recommended after finishing all puffs, especially with inhaled corticosteroids, to reduce throat irritation or thrush. Exhaling completely and placing lips around the spacer are steps done at other points in the sequence, before inhaling or during setup, not immediately after delivering a puff.