Metered-dose inhalers (MDIs) have been associated with a high rate of misuse. Medical personnel also have a poor understanding of MDI technique. Hospitalized patients had their MDI technique observed before and after a series of inservices were provided to hospital personnel on correct MDI use. The rate of misuse did not change with 55 of 72 (76 percent) patients making errors in the first group before, and 45 of 55 (82 percent) patients making errors in the second group after staff education (p = 0.46). The average number of errors per patient was 2.39 in group 1 and 2.45 in group 2 (p = 0.93). Alternatives to deal with this high rate of MDI misuse are discussed.