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1. Start with the decision
   Use page 1 to explain the decision: should the patient continue their current inhaler, improve technique, or consider a lower-emission alternative such as a DPI or SMI?

2. Compare the main options
   Use page 2 to discuss the possible benefits and harms of staying on a pMDI, improving pMDI technique, or switching to a DPI/SMI.

3. Explain the evidence carefully
   Discuss the evidence cards and the “What this evidence does not mean” section, making clear that lower-emission inhalers are not suitable for every patient.

4. Discuss what matters most to the patient
   Use the values table and patient questions to explore symptom control, ease of use, cost/PBS access, familiarity, convenience and environmental impact.

5. Check suitable inhaler options
   Use the inhaler options table to see whether a clinically appropriate DPI or SMI option exists for the patient’s treatment type.

6. Check safety, technique and access
   Before switching, consider disease stability, inhaler technique, inspiratory flow, ability to use the device, cost/PBS access, patient preference and follow-up.

7. Make and record the shared decision
   Use the final section to record the decision made, clinical considerations discussed, and document the action plan. 

8. Teach, safety-net and review
   Demonstrate the inhaler, watch the patient use it, explain what to do if symptoms worsen, and arrange follow-up.