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Written by Helen Marshall, pharmacist

Many people using metered dose inhalers (MDIs) find them hard to use. This is because it can be difficult to coordinate breathing in and pressing the inhaler at the same time. A spacer is a device designed to make an MDI easier to use, thus delivering more medicine directly into the lungs where it is needed. This makes the medicine more effective and reduces the side effects that may occur from inhaling the medicine into the mouth or throat.

A spacer device is a large plastic container, usually in two halves that click together. At one end is a mouthpiece and at the other end is a hole for inserting the mouthpiece of an MDI.

The dose from your inhaler is sprayed into the spacer, from where it can be inhaled without needing to coordinate breathing and pushing down the inhaler canister. It is particularly useful for babies and small children who do not have this coordination. Paediatric spacers have a small mask that fits onto the mouthpiece of the spacer and is placed over the child’s nose and mouth.

There are several brands of spacer device available and they are all different (including Volumatic, Nebuhaler and Aerochamber). Each spacer device fits different inhalers and so it is important to get the right spacer device that fits your inhaler. The inhaler mouthpiece must fit snugly into the spacer hole. Spacers are available on prescription.

The National Institute for Health and Clinical Excellence (NICE) recommends that spacer devices are used for children with chronic asthma. For children aged under five years they recommend that a spacer (with a facemask if necessary) is used with a metered dose inhaler for administering both inhaled bronchodilators and corticosteroids. For children aged 5 to 15 years they recommend that inhaled corticosteroids are administered in this way.

How to use adult spacers

1. Sit up straight, or stand up, and lift the chin to open the airways.
2. Remove the cap from the mouthpiece of the inhaler and shake the inhaler vigorously.
3. If you haven’t used the inhaler for a week or more, or it is the first time you have used the inhaler, spray it into the air before using it to check that it works.
4. Insert the inhaler mouthpiece into the hole in the end of the spacer (the inhaler should fit snugly and without difficulty – see below).
5. Take some deep breaths and then put your teeth around the spacer mouthpiece (not in front of it and do not bite it), and seal your lips around the spacer mouthpiece, holding it between your lips.
6. Press down on the canister in the inhaler to spray one puff of medicine into the spacer.
7. Breathe in slowly and deeply, then hold your breath for 10 seconds or as long as is comfortably possible.
8. Breathe out, then breathe in deeply again through the mouthpiece of the spacer and hold your breath. It is best to take two deep-held breaths from the spacer for each puff from your inhaler. However, if you find it difficult to take deep breaths, breathing in and out of the mouthpiece several times is just as good.
9. If you need another dose, wait 30 seconds, shake your inhaler again then repeat steps 4 to 8.
10. Don’t spray more than one puff at a time into the spacer. This makes the droplets in the mist stick together and to the sides of the spacer, so you actually breathe in a smaller dose.

How to use paediatric spacers

1. Remove the cap from the mouthpiece of the inhaler and shake the inhaler vigorously.
2. If the inhaler has not been used for a week or more, or it is the first time the child has used the inhaler, spray it into the air before it is used to check that it is working.
3. Attach the mask to the mouthpiece of the spacer.
4. Insert the inhaler mouthpiece into the hole in the end of the spacer (the inhaler should fit snugly and without difficulty – see below).
5. Place the mask over the child’s nose and mouth so that it makes a seal with the face.
6. Press down on the inhaler canister to spray one puff of medicine into the spacer.
7. Hold the mask in place and allow the child to breathe in and out slowly for five breaths.
8. If you need to give another dose, wait 30 seconds, shake the inhaler again then repeat steps 4 to 7.
9. Don’t spray more than one puff at a time into the spacer. This makes the droplets in the mist stick together and to the sides of the spacer, so the child actually breathes in a smaller dose.
10. Using a mask and spacer with a baby can sometimes be tricky. Reassure the baby by cradling them in your arms or on your knee. Gently stroke the baby’s face with the mask so that they get used to it. Talk to the baby and smile – the baby will sense if you are anxious. You can hold the mask over the baby’s nose and mouth to give them a dose while they are sleeping, and babies will also breathe in the medicine while they are crying.