Which action should be performed immediately after exhaling before inhaling through an MDI with spacer?

• A. Shake MDI and attach to spacer
• B. Place lips around mouthpiece
• C. Deliver one puff into spacer
• D. Rinse mouth with water

Answer: (B)

After you exhale, form a tight seal around the spacer’s mouthpiece with your lips. This airtight seal is essential because it prevents medication from leaking out and ensures the aerosol is captured by the spacer so it can be inhaled properly. With the seal in place, you actuate the inhaler to release a puff into the spacer and then inhale slowly through the mouth to draw the medication in, followed by a brief breath hold. Rinsing the mouth with water is a helpful post-use step, especially with inhaled corticosteroids, but it’s done after finishing the inhalation, not immediately after exhaling. Preparation steps like shaking the MDI and attaching it to the spacer occur before exhaling, while delivering one puff into the spacer follows after you’ve formed the seal and started inhaling.