Which patient using an inhaler would benefit most from using a spacer

What is a spacer?

A spacer is a clear plastic cylinder, designed to make a metered dose inhaler (MDI) easier to use. MDIs contain medications that are inhaled. Instead of inhaling directly from the inhaler, a dose from the inhaler is puffed into the spacer and then inhaled from the mouthpiece of the spacer, or with a mask attached if it is a child under the age of four years. The spacer helps deliver the medicine directly into the lungs, instead of the mouth and throat, and therefore increases the effectiveness of the medication by up to 70 percent. As many adults and most children find it difficult to coordinate the inhaler with their breathing, using a spacer is recommended for everyone who is using a metered dose inhaler, especially preventer medications.

Why should I use a spacer?

It is far easier to use an inhaler with a spacer than an inhaler alone, as you do not need to coordinate your hand and breathing.

• You can breathe in and out several times with a spacer, so if your lungs aren't working very well you don't have to get all the medicine into your lungs on one breath only.
• The spacer reduces the amount of medicine from the inhaler hitting the back of your mouth and throat, rather than going into your lungs. This reduces the local side effects from preventer medication in your mouth and throat – sore throat, hoarse voice and oral thrush. It also means that less medicine is swallowed and then absorbed from the intestine into the rest of the body. (You should still always rinse your mouth out after using your preventer medication).
• A spacer ensures you get more of the medicine you inhale into the lungs where it does the most good. This means that you may also be able to reduce the amount of medicine you need to take. If you use an inhaler without a spacer, very little medication may actually get into the lungs. 
• A spacer is as effective as a nebuliser for getting the medicine into your lungs in an acute asthma attack, but it is faster to use than a nebuliser and less expensive.

How do I use a Spacer

• Shake the inhaler.
• Fit the inhaler into spacer opening (opposite the mouthpiece) and put the spacer into your mouth ensuring that there are no gaps around the mouthpiece OR place the mask on your child’s face, covering the mouth and nose ensuring there are no gaps. Most children should be able to use the spacer without a mask by the age of four years.
• Press the inhaler once only — one puff at a time into the spacer.
• Breathe in slowly and deeply through the spacer mouthpiece and hold your breath for 5-10 seconds OR take 2-6 normal breaths, keeping the spacer in your mouth all of the time.You can breathe in and out with the spacer still in your mouth as most spacers have small vents to allow your breath to escape rather than going into the spacer. 
• If you need more than one dose of medication, wait one minute and then repeat these steps for further doses, making sure that you shake your inhaler between doses.
• If using a mask with preventer medication, wash the child’s face after use.
• Wash your spacer once a week and before using it for the first time with warm water and dishwashing liquid. Don’t rinse. Drip dry. This reduces the electrostatic charge so that the medicine does not stick to the sides of the spacer.  
• Check for any cracks.  If used regularly your spacer may need to replaced every 12-24 months.

How do I get a spacer?

Spacers are available free of charge from your general practitioner or respiratory educator at one of our asthma societies. 

What is a spacer?

A spacer is a holding chamber shaped like a football or tube. It makes it easier to take asthma or COPD medication from the type of puffer called an MDI (metered dose inhaler).

Spacers help the medication get straight to where it’s needed in your lungs, with less medication ending up in your mouth and throat where it can lead to irritation or mild infections. A spacer can also make it easier to coordinate breathing in and pressing your puffer.

Spacers should be used by:

• all children – kids aged under 4–5 years will need a mask attached
• all adults taking a corticosteroid preventer medication (e.g. Flixotide, Symbicort) using an MDI/puffer
• adults who have trouble coordinating the ‘press and breathe’ technique when using an MDI/puffer
• anyone taking a reliever medication (e.g. Ventolin) during an asthma attack.

Why not use a nebuliser?

All the latest research shows that a puffer with spacer works just as well as a nebuliser for treating asthma symptoms, including during an asthma attack. A puffer with spacer is also simpler, cheaper and handier, is much more portable, and has fewer side-effects.

Choosing a spacer

There are many different brands and sizes of spacers available. Ask your pharmacist, nurse or asthma educator about which spacer might be best for you or your child. Look for one that you can put together easily and that will be convenient for everyday use.

Tips for using your spacer

• Fire only one puff into your spacer at a time
• Breathe in from your spacer as soon as you've fired a puff into it – the medication settles on the bottom very quickly
• For each puff, you can either:
  *  take one big breath in - breathe in slowly, deeply and fully and hold breath for about 5 seconds (recommended) OR 
  *  breathe in and out normally for 4 breaths (tidal breathing) if you are unable to take one big breath in.

Remember to shake your puffer before firing each puff.

Check you have the steps right by watching a short video showing how to use a puffer and spacer correctly in our How-to video library.

Cleaning your spacer

Clean your spacer about once a month and after you have recovered from any cold or respiratory infection. Your spacer may become a bit cloudy over time, but it shouldn’t be mouldy or brown.

To clean your spacer:

• Dismantle your spacer, if necessary
• Wash all the parts in clean warm water with liquid dishwashing detergent
• Allow the parts to air dry without rinsing – drying with a cloth or paper towel can result in static building up on the inside of the spacer, which makes the medication stick to the sides
• Wipe the mouthpiece clean of detergent, if needed
• When completely dry, reassemble if necessary

New spacers (e.g. Able Spacer Universal, Breath-A-Tech, Volumatic) also need to be washed before you use them for the first time. If a new spacer has to be used immediately, you can ‘prime’ the spacer by firing at least multiple (at least 10) puffs into it to begin with to help reduce the static build-up inside. You can then take your medication dose as usual.

Spacers made from antistatic polymers (e.g. Able A2A, AeroChamber Plus, Breathe Eazy, La Petite E-Chamber, La Grande E-Chamber, OptiChamber Diamond) do not need to be primed or washed before first use, nor do disposable cardboard spacers.

Your spacer should be checked by your pharmacist, nurse or asthma educator every 6–12 months to check the structure is intact (e.g. no cracks) and the valve is working properly.

Disclaimer

It is important to note that information contained in this brochure is not intended to replace professional medical advice. Any questions regarding a medical diagnosis or treatment should be directed to a medical practitioner. 

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