A 45-year-old female presents to the pharmacy with a new prescription for an albuterol (Salbutamol) metered-dose inhaler (MDI) for asthma. She has never used an inhaler before. Which of the following instructions is most important to ensure proper MDI technique?

Question: A 45-year-old female presents to the pharmacy with a new prescription for an albuterol (Salbutamol) metered-dose inhaler (MDI) for asthma. She has never used an inhaler before. Which of the following instructions is most important to ensure proper MDI technique?

Answer options:

• Shake the inhaler vigorously 2-3 times before each puff.
• Inhale slowly and deeply through your nose while pressing down on the canister.
• Hold your breath for at least 10 seconds after inhaling the medication. ✅ Exhale fully before placing the mouthpiece in your mouth and pressing down.

Correct answer: Exhale fully before placing the mouthpiece in your mouth and pressing down.

Explanation: Exhaling fully before inhaling is crucial to create space in the lungs for the medication to enter effectively. While other steps (shaking, breath-holding) are important for MDI use, incomplete exhalation significantly compromises delivery. Inhaling through the nose is incorrect; one should inhale slowly and deeply through the mouth.