In this series, we will be highlighting a range of respiratory-related devices and explaining best practice on how to use these. In this issue, we demonstrate how to use a spacer, and why it is important to use one.
Spacers are clear plastic cylinders with a mouthpiece or mask at one end, and an opening for your metered-dose inhaler (MDI) at the other. MDIs contain aerosol medications that are inhaled. So instead of inhaling directly from the inhaler, a dose from the inhaler is puffed into the spacer, and a valve in the spacer mouthpiece opens as you breathe in, and closes as you breathe out. 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 an MDI, especially preventer medications.
Many adults and children are unable to use their MDI effectively, so using a spacer reduces the need to have a perfect inhaler technique. Spacers are designed to deliver up to twice the medication of an inhaler alone, this means that 50% more medicine enters the lungs when a spacer is used. This also means that less medicine gets left in the mouth and throat, which reduces the chance of side effects from your preventer medicine, such as hoarseness, or oral thrush. However, it is still important to always rinse your mouth out after using your preventer medication. Another advantage is that less medicine is swallowed and absorbed from the intestine into the rest of the body. A spacer can help when you are short of breath and is a smaller, convenient alternative to a nebuliser. In fact, studies on adults and children, show spacers work just as well as nebulisers for acute asthma.
1- Remove the cap and shake the MDI inhaler. Fit the inhaler into a spacer opening (opposite the mouthpiece).
2- Put the spacer into your mouth ensuring that there are no gaps around the mouthpiece. Press the inhaler once only — one puff at a time into the spacer.
3- 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 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 back into the spacer.
4- 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.
Using a spacer with a mask can be helpful for small children who struggle to take the breaths required when using a traditional spacer. If you are using a mask together with a spacer for your child, place the mask on your child’s face, covering the mouth and nose, ensuring there are no gaps. Masks are commonly used for babies and infants who cannot seal their lips around the mouthpiece. Most children should be able to use the spacer without a mask by the age of four years. If you are using a mask with preventer medication, wash the child’s face after use.
Wash your spacer (and mask if using one) once a week with warm water and dishwashing liquid, and don’t rinse - drip dry. This reduces the electrostatic charge so that the medicine does not stick to the sides of the spacer. Check your spacer regularly for cracks. If used often, your spacer may need to be replaced every 12 months.
You can access a free spacer from your healthcare provider or asthma society. For more information on spacers visit: www.asthmafoundation.org.nz/your-health/living-with-asthma/spacer