1. Remove dust cover Remove the dust cover from the inhaler 2. Clear the mouthpiece Clear the mouthpiece by tilting it forward and blowing out any dust or other loose material. 3. Grip the inhaler Correctly position the inhaler comfortably in the hand. 4. Shake the inhaler Shake the inhaler vigorously 10-15 times to mix the propellant and the drug. 5.Priming new inhalers If the MDI is new, activate one spray into the open air to prime the delivery system.   6. Inhaling a breath Inhale a comfortable breath 7. Exhaling a breath Exhale comfortably to remove most of the air from the lungs. 8. Inhaler placement in mouth Place the MDI mouth piece in the mouth and past the front teeth. 9. Head position Tilt the head back slightly (about 45 degrees).   10. Inhalation and spray activation Begin slow deep inhalation through the mouth only AND activate the MDI by pressing down the canister to release the a single dose of the aerosol spray. 11 Holding breath Following a slow full inhalation; hold your breath about 10 seconds or as long as you feel comfortable, to allow aerosol to deposit at site of action in smaller airways.   12. Exhaling Breathe out slowly through nose or pursed lips. 13. Second puff If a second puff from the MDI is needed, wait at least 1-5 minutes between doses and shake the MDI vigorously prior to the second puff in the same manner as the first puff. 14. Cleaning the mouthpiece To clean the inhaler, remove the metal canister from plastic sleeve. Wash the sleeve with warm water and dry it thoroughly before reusing. 15. Discarding and refilling cannister The number of doses that will be accurately delivered from the canister is listed on the label.