Which of the Following Is the Optimal Technique for Use

Which of the following is the optimal technique for use of a metered dose inhaler?
1) Actuating the inhaler with the mouthpiece 4 cm from the patient's opened mouth
2) Placing the inhaler in the mouth and closing the lips tightly
3) Holding breath for 5 to 10 seconds after inhalation
4) Not waiting between actuations
5) Inhaling the aerosol quickly

A) 1 and 3
B) 1,3,and 4
C) 2,3,and 5
D) 2,4,and 5