Which of the following is NOT a recommended step when delivering a dose via a metered-dose inhaler with a spacer?

• A. Shake MDI and attach to spacer
• B. Exhale through mouthpiece
• C. Take a slow deep breath and hold for 10 seconds
• D. Rinse mouth with water after dose

Answer: (B)

Coordinated inhalation with a spacer aims to get the medication into the lungs and minimize it being deposited in the mouth or throat. The sequence should start with shaking the inhaler and attaching the spacer to ensure proper aerosolization. Then you exhale fully away from the spacer, not through it, before placing your lips around the mouthpiece. Press the inhaler once and inhale slowly and deeply through the mouth to draw the medication into the lungs, then hold the breath for about 10 seconds to allow for maximum deposition. After finishing, remove the spacer and rinse the mouth with water if you’re using a corticosteroid inhaler to reduce the risk of oral thrush. Exhaling through the mouthpiece disrupts the device’s aerosol delivery and is not recommended.