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How to use a meter dose inhaler with a valved holding chamber, 
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also commonly referred to as a spacer. 
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Check the dose counter on the inhaler. 
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Do not use it if it says zero. Zero means the inhaler is empty 
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and needs to be replaced. 
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Prime a brand new inhaler before using it for the first time. 
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This prepares the inhaler for use.
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Prime the inhaler by shaking it for 10 seconds and spraying two or four puffs into 
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the air based on your medicine instructions. 
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Prime again if you have not used this inhaler for 1 to 2 
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weeks or have dropped it.
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Priming does not waste doses. 
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To take a dose,
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shake the inhaler to mix the medicine. 
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Take the cap off the inhaler and make sure 
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the mouthpiece and valved holding chamber are 
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clean and there's nothing inside the mouthpieces.
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Place the inhaler mouthpiece into the open end of the 
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valved holding chamber. 
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Remove the valved holding chamber mouthpiece cap.
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Prepare your body by sitting or standing up straight. 
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Hold the inhaler with your pointer finger on the top of 
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the inhaler and thumb on the bottom. 
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Tilt head back slightly. 
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Put the mouthpiece of the holding chamber into 
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your mouth, above your tongue. 
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Close your lips tightly around the mouthpiece. 
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Press down on the top of the inhaler once to release the
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medicine and begin to breathe in through your mouth. 
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Keep your lips closed around the mouthpiece. 
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Breathe in for 3 to 5 seconds, using one deep and steady 
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breath to pull the medicine into your lungs. 
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If the holding chamber whistles, you are 
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breathing in too fast. 
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Remove the chamber from your mouth and hold your breath for 
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up to 10 seconds. 
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Breathe out slowly through your mouth. 
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Repeat these steps in one minute 
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if using more than one puff. 
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Rinse your mouth with water and spit it out. 
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Replace the cap and store in a cool dry place. 
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Clean your inhaler chamber spacer according to their package instructions. 
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If you have trouble using the inhaler correctly, ask your 
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pharmacist or doctor for help.