Background. Poor pressurised metered-dose inhaler (pMDI) technique remains a challenge in the management of airway diseases. Objectives. To assess pMDI technique among respiratory outpatients and identify the main indications for pMDI use and factors associated with improper use. Methods. This was a prospective, quantitative descriptive study conducted at the adult respiratory clinic of Universitas Academic Hospital in Bloemfontein, South Africa. A convenience sample of 100 participants was used. Each participant was interviewed and required to demonstrate the use of a placebo pMDI, either alone or with a large-volume spacer. Inhaler technique was evaluated according to the UK Inhaler Group standard for inhaler therapy. Results. Chronic obstructive pulmonary disease and asthma were the most common indications for pMDI use. Of the 100 participants, 97 preferred a pMDI without a spacer (pMDI alone) and three preferred using the inhaler with a spacer. In the pMDI-alone group, 13 participants (13.4%) demonstrated correct technique and 65 (67%) made more than one error. Conclusion. Poor inhaler technique is common among respiratory outpatients. Every contact with the patient should be an opportunity to reinforce correct pMDI technique.