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The cap is a small covering located over the mouthpiece of the inhaler to prevent foreign objects from getting in the inhaler. Pull the cap to remove it and set it in a safe place.  An uncapped inhaler can pick up germs and debris, which you will then pump into your lungs. Make sure that you don't lose your cap while you're using your inhaler. The inhaler should be clean, especially the mouthpiece. Remove the cap and check the inside and outside of the mouthpiece. Check the expiration date to make sure that it can still be used. Wipe any grime or debris off the inhaler with a dry tissue or cotton swab. If the mouthpiece is dirty, wipe it down with rubbing alcohol, and let it dry. Hold the inhaler in your hand with your index finger on top of the canister. The mouthpiece should be on the bottom with the top of the canister pointing up. Quickly move your inhaler up and down by pumping your forearm or wrist. If you haven't used it in a while, make sure that you prime it by pumping it until it sprays at full force. Don't worry about wasting medicine because an unprimed inhaler will not provide you a full dose, putting your breathing at risk. Instructions for priming vary, so know how many pumps it takes to prime yours. Take off the cap and look inside to make sure that there is no grime or debris inside the spacer. If there is, then try blowing it out. If you can't clear out the debris, you may need to wash your spacer.  Don't wipe your spacer with a cloth because it will create static cling that attracts your medicine.  Clean your spacer by dismantling and washing it in mild dish detergent. Allow it to air dry before putting it back together. Breathe in through your mouth. Open your lungs to their maximum capacity, then hold the breath for just a second. You only need to slightly tilt your head back. This will open your airways so that the medicine can easily flow into your lungs. If you bend your head too far back, you may cut off your throat instead of opening it, however. Release the air from your lungs in preparation for inhaling your medicine from the inhaler. The mouthpiece should sit above your tongue and between your teeth. Close your lips around it, and aim the spray hole at the back of your throat.  If you're using a spacer, the mouthpiece on the spacer goes in your mouth, and the mouthpiece of the inhaler fits in the other end of the spacer.  If you don't have a spacer and don't want to put the inhaler in your mouth, then you can hold it 1-2 inches in front of your mouth. Begin inhaling slowly through your mouth as you press down on your inhaler. This will release a dose of your medicine. Keep the mouthpiece in your mouth to help keep the medicine in your mouth. Continue to breathe in for about three to five seconds. Try to push the medication back towards your lungs as you inhale. This movement is known as a "puff."  Only press the canister down once. If you're holding your inhaler 1-2 inches in front of your mouth, then close your mouth as soon as the dose is delivered. If you're using a spacer, some spacers have a whistle on them. Listen for the whistle. If you hear it, you are breathing in too rapidly. If you don't hear it, you are breathing in at an acceptable rate. Your medicine needs time to work, and exhaling too quickly can allow the medicine to escape. You should aim to hold the medicine in your mouth for at least ten seconds, but try to see if you can wait up to a minute. You only have to count to ten on breaths you take from your inhaler. Exhale slowly and deeply through your mouth, and then resume breathing normally. Rinse your mouth with water thoroughly after using the inhaler. Gargle, then spit the water out.   If you're supposed to take two puffs from your inhaler, wait one minute before repeating the process. Continue to use your inhaler as directed by your doctor. In general, most people take one or two puffs every four to six hours or as needed. It's especially important to rinse your mouth if your medication is steroid-based because the medicine can cause a secondary yeast infection in the mouth called thrush. Rinsing your mouth after use will help prevent this.

Summary:
Remove the cap. Inspect the inhaler. Hold the inhaler upright and shake it 5-10 times. Prepare your spacer if you're using one. Take a deep breath. Tilt your head back. Exhale slowly. Place the inhaler or the inhaler with the spacer in your mouth. Breathe in as you press down on the canister. Hold your breath and count to 10. Remove the mouthpiece from your mouth.