1 - Remove the cap of the inhaler and spacer
2 - Shake the inhaler up and down
3 - Attach the inhaler to the back of the spacer
4 - Breathe out fully
5 - When breathing out fully, breathe out away from the spacer
6 - Put the spacer mouthpiece or the MDI mouthpiece (if not using the spacer) into the mouth and close your lips around the mouthpiece
7 - Activate the inhaler by pressing down on the canister 1 time
8 - Breathe in slowly, filling the lungs with medicine; no whistle should be heard
9 - Hold breath for at least 5 seconds (10 seconds is better) with or without the spacer in the mouth
10 - Remove the spacer/MDI from the mouth before breathing normally
11 - Breathe normally for at least 30-60 seconds
12 - Repeat sequence for the second puff
