 [ Symptoms ] confused my menstrual cycle was supposed to be 23rd til 27th and its the 29th of january and still have not gotten my period [ Disease ] these are the general steps for using a metered dose inhaler for chronic obstructive pulmonary disease 1 remove the cap from the metered dose inhaler 2 shake the inhaler for a few seconds 3 place your index finger on top of the canister and thumb on the bottom of the mouthpiece 4 tilt your head back slightly and breathe out 5 hold the inhaler upright about the width of two fingers from your mouth 6 breathe in and out slowly through your mouth one time 7 press down on the inhaler as you breathe in as slowly and deeply as you can    about three to five seconds 8 if possible hold your breath for at least 10 seconds 9 if your doctor prescribed more than one puff of copd medication wait about one minute and repeat steps 2 through 8 10 replace the cap on the metered dose inhaler 11 gargle and rinse your mouth with water or mouthwash usually advised only for steroid type inhalers