Assemble the spacer and attach to the MDI mouthpiece. The other steps are the same as an MDI without a spacer. Remove spacer after finishing.
It is recommended to clean the spacer every 1-2 weeks when it is used frequently. Wash the spacer with warm water and a small amount of dilute soap. Washing with water alone allows the buildup of electrostatic charge, thus reducing spacer effectiveness. Air-dry the spacer for future use.