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Shaking the inhaler gently is crucial for ensuring that the medication is well mixed before use, particularly for MDIs that contain suspension formulations. When the inhaler is shaken, it helps to evenly distribute the drug particle within the propellant, ensuring that the patient receives the appropriate dose of medication when they activate the inhaler. Proper technique also enhances the effectiveness of the medication delivery into the lungs.

In contrast, inhaling through the nose, taking a fast deep breath, and holding the inhaler upside down are not effective techniques for using an MDI. Inhalation should be done through the mouth to facilitate better entry of the medication into the lungs, and a slow, deep breath is recommended to allow for better aerosol deposition within the airways. Lastly, holding the inhaler upside down might misdirect the aerosolized medication, leading to reduced delivery to the target site.