What is a spacer?
A spacer is a tube-shaped device that attaches to your inhaler to help deliver medication to your lungs. Think about a spacer as an accessory for your inhaler.
Should I use a spacer with all inhalers?
No, the spacer only helps with certain inhalers where the medication is sprayed into the air. These types of inhalers are called metered dose inhalers (MDIs) or “puffers”. You can identify them because they have a metal canister on the back. A common one is your albuterol (Ventolin ®) inhaler. The metal canister is filled with medication and a propellant, which pushes the medicine out and makes it into a spray.
How does the spacer help?
People are often taught that they need to time their breath in with the quick spray from their puffer. But, for some people, it is difficult to get that timing is right. If they cannot breathe in at exactly the right time, the medication is sprayed on their tongue and throat, where it cannot help their breathing, and the medication does not reach their lungs, where it is needed.
A spacer helps because it is a “holding chamber” for the medication spray, so the person can take more time to breathe in the medication effectively.
Who needs a spacer?
A spacer is recommended for most children 5 years old and younger. A spacer may also be recommended for some elderly patients who have trouble timing their breath in with the sprayed medication. A spacer with an added face mask attachment may be preferred for children under 3 years old.
How do I use it? (Adapted from “Spacer devices for inhaled therapy: why use them, and how?”)
Preparation:
- If this is the first time you are using this inhaler, you may need to “prime” it before starting. There should be instructions with your particular inhaler – but usually that means spraying it into the air a few times. This is to ensure medication is sprayed at an even amount when you first use it. Do not worry – you are not losing medication – the inhaler is filled with these extra doses.
- If this is the first time you are using the spacer, spray the inhaler once into the spacer before using it. Priming the spacer reduces the static electricity inside the spacer, ensuring the medication does not stick to the sides when you breathe in medication.
Using the spacer with the inhaler:
- Sit or stand up straight with your chin up.
- Shake the inhaler five times and remove the cap.
- Hold the inhaler upright (with the canister up) and fit it into the spacer. Hold the inhaler with one hand (holding it between the index finger and thumb so you are ready to spray), and the other hand supporting the mouthpiece at the end of the spacer.
- Breathe out.
- Place the spacer’s mouthpiece between your teeth and seal the lips around it (or place the mask gently but tightly over the nose and lips).
- Breathe in slowly, immediately press the inhaler once and continue to breathe in deeply and slowly over 4–5 seconds until the lungs are full.
- Some spacers come with a whistle. If you hear a whistle, you are breathing in too quickly.
- Hold your breath for 10 seconds or for as long as you can. While holding your breath, take the spacer out of your mouth (or lower the mask) and relax.
- Breathe out.
- If the directions on your medication say to do 2 puffs, repeat the entire sequence for each puff, including shaking the inhaler if needed. Multiple doses should never be fired together into the spacer to be inhaled in a single breath.
- When you are done, take the inhaler out of the spacer and place the cap back on the inhaler.
- If your medication contains a steroid, like Flovent® (fluticasone), Pulmicort® (budesonide), Qvar® (beclomethasone), or it is a medication combined with a steroid, like Symbicort® (budesonide/formoterol), then you need rinse your mouth and gargle with water afterwards. If you do not know if your inhaler contains a steroid, ask your provider or pharmacist.
Sometimes it is easier to learn by watching a video – see watch someone using a spacer in this video:
https://www.youtube.com/watch?v=sQUUJHzO-XQ&t=122s
Some children or adults cannot take slow, long breaths. If they are not able to take slow long breaths, the breathing directions are a little different and they will need some help. Instead, you will place the face mask over their nose and mouth, spray the medication, and have them breathe normally for 5 breaths. Watch this video to learn more –
https://www.youtube.com/watch?v=bkRKd9oAXUA
How important is it to use a spacer?
The official guidelines for asthma from the Global Initiative for Asthma strongly recommend a spacer to improve delivery of the medicine to the lungs. This is important, as effective medication delivery can help the person breathe more easily and improve lung function too! Additionally, these guidelines report that using a spacer with steroid inhalers reduces the risk of side effects too (like yeast infections of the mouth and voice changes), as less of the medication is sprayed on the tongue and mouth.
Can I share my space with my family members?
No, spacers should not be shared with family members. This is to avoid transmitting bacteria or infection from one person’s mouth to another.
How do I wash a spacer? (Adapted from “Spacer devices for inhaled therapy: why use them, and how?”)
- Take apart the spacer after the last dose of the day
- Immerse the parts in a basin containing lukewarm tap water with a few drops of soap
- Shake the parts in the water and rub them with a soft cloth
- Leave the parts soaking for 15 minutes
- Take them out of the water
- Do not rinse or dry rub the inside of the parts
- Rinse soapy water off the mouthpiece
- Place the parts on a clean towel to air-dry overnight
- Reassemble the parts the next morning and check that the valve is not stuck
It is recommended to wash your spacer once weekly.
Are spacers covered by insurance?
Some insurance plans cover them, while others do not, and costs can range from $10-$15 or more. Talk to your pharmacist to learn more.
Do I need to get a new spacer periodically?
Spacers should be replaced at least once a year. According to manufacturers, the lifetime of a spacer is usually 6 and 12 months.
In summary, many people struggle to coordinate their breath with the spray of medication from an inhaler. Talk to your provider or pharmacist about whether you could benefit from a spacer.
Prepared by: Garbo McDermott-Grossman, PharmD, Pharmacy Resident
Sources:
Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2024. Updated May 2024. Available from: www.ginasthma.org.
Vincken, Walter et al. “Spacer devices for inhaled therapy: why use them, and how?.” ERJ Open Research vol. 4,2 00065-2018. 18 Jun. 2018, doi:10.1183/23120541.00065-2018
