What is the correct spacer technique for metered-dose inhalers to maximize drug deposition?

• A. Exhale fully, seal lips around spacer, coordinate actuation with slow deep inhalation, hold breath 5-10 seconds, wait 1 minute between puffs; rinse mouth after corticosteroids; keep spacer clean
• B. Inhale rapidly without exhaling, actuate with fast inhalation, and do not rinse mouth
• C. Take two puffs back-to-back without rest
• D. Use spacer only with dry powder inhalers

Answer: (A)

Maximizing lung deposition with an MDI using a spacer hinges on coordinating spray with a slow, deep inhalation and a breath hold. Start with a full exhale, seal lips around the spacer, and actuate as you begin a slow, deep inhalation. After inhaling, hold your breath for about 5–10 seconds to let the particles deposit, then exhale. If another puff is needed, wait about a minute between puffs. For corticosteroids, rinse the mouth after use to reduce thrush risk, and keep the spacer clean to maintain effectiveness. In contrast, rushing the inhalation or firing puffs back-to-back without a rest reduces lung deposition; spacers are used with MDIs (not DPIs), so using one with a dry powder inhaler isn’t appropriate.