How to Use a Spacer Correctly with an Inhaler

For millions of people managing asthma or other respiratory conditions, the metered-dose inhaler (MDI) is a familiar, life-sustaining tool. This small device delivers a measured puff of medication directly into your airways to relieve symptoms or prevent them from starting. However, using an inhaler correctly is more challenging than it looks. It requires a precise sequence of actions: pressing the canister, breathing in deeply at the exact right moment, and holding your breath. When this timing is off, a significant portion of the medication can end up on your tongue or in the back of your throat instead of deep within your lungs where it's needed.

This common problem significantly reduces the effectiveness of the treatment and can lead to frustratingly poor symptom control. Fortunately, there is a simple and highly effective solution: using a spacer. A spacer, or valved holding chamber, is a device that attaches to your inhaler to make it easier to get the full dose of medication.

This guide will provide everything you need to know about using a spacer. We'll explore why they are so crucial, break down the different types available, and offer a detailed, step-by-step process for using one correctly. Mastering this technique can transform the effectiveness of your treatment, leading to better breathing and improved health.

What is a Spacer and Why is it so Important?

A spacer is a hollow chamber, usually made of plastic, that fits onto the mouthpiece of a metered-dose inhaler. When you press the inhaler canister, the medication is sprayed into the chamber. From there, you can inhale it slowly and deeply. More advanced versions, known as valved holding chambers (VHCs), have a one-way valve that traps the medication inside the chamber, giving you more time to breathe it in. The valve also prevents you from accidentally exhaling into the chamber.

For anyone using an MDI, a spacer is not just an optional accessory—it should be considered an essential part of the treatment. The benefits are too significant to ignore.

The Overwhelming Benefits of Using a Spacer

1. Maximizes Medication Delivery to the Lungs: The primary benefit of a spacer is that it dramatically increases the amount of medication that reaches your lungs. Without a spacer, much of the medication travels too fast and the particles are too large, causing them to impact the back of the throat. A spacer slows the aerosol cloud down and allows the particles to become smaller, making them easier to inhale deep into the smaller airways. Studies have shown that using a spacer can improve lung deposition by over 75%.

2. Reduces the Need for Perfect Coordination: The biggest challenge with an MDI is timing. You have to press down and begin inhaling slowly in the same split second. This "press-and-breathe" coordination is difficult for many adults and nearly impossible for young children. A spacer eliminates this problem entirely. You can press the canister to fill the chamber with medication and then take a slow, deep breath. VHCs even allow you to take multiple breaths to get the full dose.

3. Minimizes Side Effects: When medication from an MDI deposits in the mouth and throat, it can cause unpleasant local side effects. For rescue inhalers containing albuterol, this can cause a jittery feeling. For controller inhalers with inhaled corticosteroids, it can lead to a sore throat, hoarseness, and an oral fungal infection known as thrush. By directing the medication away from the mouth and into the lungs, a spacer significantly reduces the risk of these side effects.

4. Makes Medication More Effective: By ensuring the correct dose reaches the lungs, a spacer makes your medication work better. This can lead to improved asthma control, fewer symptoms, and a reduced need for your rescue inhaler. For some people, it can mean the difference between managing their condition and struggling with frequent flare-ups.

Given these benefits, it's clear why medical professionals universally recommend spacers for all patients using MDIs, from infants to the elderly. They are a critical tool for effective respiratory care.

Preparing Your Spacer for First-Time Use

Before you use a new spacer for the first time, it needs to be primed. Out of the box, plastic spacers often have a static charge on the inside walls. This static can attract the medication particles, causing them to stick to the sides of the chamber instead of being available for you to inhale.

How to Prime Your Spacer:

1. Wash It: The best way to reduce static is to wash the spacer before its first use. Disassemble the spacer according to the manufacturer's instructions. Wash the parts in warm water with a small amount of liquid dish soap.

2. Do Not Rinse: Rinsing the soap away can reintroduce static. Instead, simply let the pieces air dry completely. A thin film of soap residue helps to coat the chamber and prevent static buildup.

3. "Prime" with Puffs (Alternative Method): If you are unable to wash the spacer, you can prime it by firing several puffs of your inhaler (around 10-15 puffs) into the chamber without inhaling. This coats the inside with medication particles, which helps reduce the static charge for subsequent uses. However, washing is the preferred method.

This simple preparation step ensures your spacer will work efficiently from the very first dose.

A Step-by-Step Guide to Using an Inhaler with a Spacer

Using a spacer is straightforward once you learn the correct technique. Following these steps will help you get the most out of your medication every time.

Step 1: Get Ready

• Gather Your Equipment: Get your metered-dose inhaler and your spacer.

• Check Your Inhaler: Remove the cap from the inhaler's mouthpiece. Check to make sure there are no foreign objects inside. Shake the inhaler vigorously for about 5-10 seconds. This mixes the medication with the propellant to ensure a consistent dose.

• Prime the Inhaler (If Necessary): If your inhaler is new or you haven't used it in a while (check the instructions, but typically >2 weeks), you need to prime it by spraying a few puffs into the air, away from your face.

Step 2: Assemble the Devices

• Remove the cap from the spacer’s mouthpiece.

• Insert the mouthpiece of the inhaler into the rubber-sealed opening at the back of the spacer. The fit should be snug.

Step 3: Position Yourself and Exhale

• Sit or stand up straight. This helps open your airways and allows your lungs to expand fully.

• Breathe out gently and completely, emptying your lungs of air. Do not breathe into the spacer.

Step 4: Administer the Medication

• Bring the spacer’s mouthpiece to your mouth and create a tight seal with your lips. Your teeth should be on the inside of the mouthpiece.

• Press down firmly on the top of the inhaler canister one time. This will release one puff of medication into the chamber.

• Do not press the canister multiple times. Administer only one puff at a time.

Step 5: Inhale the Medication

This step can be done in two ways, depending on what is most comfortable and effective for you.

Method 1: Single Slow, Deep Breath

• Immediately after pressing the canister, begin to breathe in slowly and deeply through your mouth. Aim for the inhalation to last about 3 to 5 seconds. You should hear the valve "click" or "flutter" if you have a VHC. If you hear a whistling sound, you are breathing in too quickly.

• Hold Your Breath: Once your lungs are full, remove the spacer from your mouth and hold your breath for up to 10 seconds. This gives the medication time to settle deep into your airways.

• Exhale: Breathe out slowly.

Method 2: Multiple Normal Breaths (Tidal Breathing)

This method is often recommended for children or for anyone who has trouble taking a single deep breath, especially during an asthma flare-up.

• Keep the spacer mouthpiece sealed with your lips.

• After pressing the canister, breathe in and out normally through the chamber for about 4-6 breaths. The one-way valve in a VHC will trap the medication, allowing you to inhale it over several breaths.

• Remove the spacer from your mouth.

Step 6: Wait and Repeat (If Necessary)

• If your doctor has prescribed more than one puff, wait about 30-60 seconds before repeating the process. This allows the first puff to start working to open the airways, which helps the second puff penetrate even deeper.

• Remember to shake the inhaler again before administering the next puff.

• Repeat steps 3 through 5 for each prescribed puff.

Step 7: Clean Up

• When you are finished, remove the inhaler from the spacer.

• Replace the caps on both the inhaler and the spacer mouthpieces to keep them clean.

• Rinse Your Mouth: If you used an inhaler containing a corticosteroid, it is very important to rinse your mouth with water, gargle, and then spit the water out. This removes any medication left in your mouth and throat, preventing side effects like thrush.

Special Considerations for Children and Infants

Using a spacer is the only effective way to deliver MDI medication to young children and infants. For this age group, the spacer is fitted with a face mask instead of a mouthpiece.

Using a Spacer with a Face Mask:

1. Follow the same initial steps: shake the inhaler, attach it to the spacer, and remove the mask's cap.

2. Gently place the mask over the child's nose and mouth. The goal is to create a good seal against the skin. Crying can interfere with medication delivery, so try to make the experience as calm as possible.

3. Press the inhaler canister one time to release a puff into the chamber.

4. Hold the mask in place while the child breathes in and out for about 6 breaths (or about 10 seconds).

5. If a second puff is needed, wait 30-60 seconds and repeat the process.

How to Clean and Care for Your Spacer

Proper maintenance is essential to keep your spacer working correctly and hygienically. A dirty spacer can harbor germs and may not deliver medication effectively due to static buildup.

Weekly Cleaning Routine:

1. Disassemble: Take the spacer apart according to the manufacturer's instructions. Most models have a removable back piece and mouthpiece.

2. Wash: Soak the parts in warm water with a small amount of mild liquid detergent for a few minutes. Gently agitate the parts in the soapy water. Do not use a brush or cloth to scrub the inside, as this can create scratches and increase static.

3. Air Dry: Do not rinse the soap off. Place the parts on a clean towel or drying rack and let them air dry completely. Wiping them with a cloth can create lint and static electricity.

4. Reassemble: Once all the parts are completely dry, put the spacer back together.

When to Replace Your Spacer:

Spacers don't last forever. The plastic can degrade, and the valves can wear out over time. It is generally recommended to replace your spacer every 6 to 12 months, or as directed by the manufacturer or your doctor. Inspect it regularly for cracks or damage.

Finding the Right Asthma Supplies

Having the right equipment is fundamental to managing any respiratory condition. Whether you need a new spacer, a portable nebulizer for more intensive treatments, or a peak flow meter to monitor your lung function, it's important to use high-quality, reliable products. Explore a comprehensive collection of asthma supplies to find the tools that best fit your needs. Partnering with a trusted supplier of medical equipment, from respiratory supplies to mobility aids, ensures you receive effective and safe products.

Take Control of Your Breathing

Learning to use a spacer correctly is one of the most powerful things you can do to improve your asthma management. It's a simple change that can lead to a profound difference in your health. By ensuring that your medication reaches your lungs efficiently, you gain better symptom control, reduce side effects, and empower yourself to breathe more freely.

Talk to your doctor or pharmacist if you have any questions about your inhaler or spacer technique. They can watch you use it and provide personalized feedback. With a little practice, using your spacer will become a quick and easy habit that pays huge dividends for your respiratory health.