Family doctor

What is a spacer?

A spacer is a large chamber which is fitted to an inhaler (for asthma, emphysema or bronchitis). Instead of inhaling directly from the inhaler, a dose from the inhaler is sprayed into the spacer then the spacer is inhaled from, either through a mouthpiece or a mask.

The advantages of a spacer are:

• You do not need to coordinate with an inhaler.
• You can breathe in and out several times with the chamber, so if your lungs aren't working very well you don't have to get all the medicine on one breath only.
• The spacer reduces the amount of medicine from the inhaler which hits the mouth and throat rather than going to the lungs. The benefit of this is that you have less side effects in the mouth and throat e.g. hoarseness or oral thrush from steroid inhalers. Additionally, less medicine will be swallowed and then absorbed from the intestine into the rest of the body, which is also good.
• Usually with a spacer you will get more of the medicine you inhale into the lungs where it does the most good.
• For a child it is far easier to use an inhaler with a spacer than the inhaler alone.
• A spacer may be as effective as a nebuliser for getting the medicine to your lungs, but is faster to use than a nebuliser, and less expensive.

As many adults and most children cannot coordinate very well with their inhaler, using a spacer is a good idea for nearly everyone who is using an inhaler.

There are a variety of spacers on the market including:

• Aerochamber
• Breath-A-Tech
• Fisonair
• Nebuhaler
• Volumatic

Some spacers are made to fit certain inhalers only. The Breath-A-Tech will fit most inhalers and has an optional child or adult mask to fit the mouthpiece if required.

How to use:

1. Shake the inhaler well.
2. Fit the inhaler to the inhaler hole in the opposite end of the spacer to the mouthpiece and spray one puff into the spacer.
3. Put your mouth around the mouthpiece ensuring there are no gaps. Breathe slowly and deeply from the mouthpiece of the spacer and hold the breath for 10 seconds if possible. Repeat two or three times with the mouthpiece still in the mouth. You can breath out with the mouthpiece still in the mouth for most spacers as they have little vents to allow your breath to escape rather than going into the spacer.
4. If the doctor has prescribed two doses for you, wait for one minute then follow steps 1 to 3. Never spray the two puffs into the spacer together as it is not nearly as effective as doing them separately.

If a mask is being used make sure the mask is placed firmly on the face, and after use with steroid inhalers wipe the face clean with warm water.

For children, instead of holding the breath for 10 seconds they could take five deep slow breaths instead.

Cleaning:

Your spacer should be cleaned regularly, e.g. once a week, and before first usage. Sometimes it is recommended that before the very first use (i.e. when brand new) it has 10 puffs of the reliever (bronchodilator) inhaler, e.g. Ventolin, Bricanyl, Airomir, sprayed into it. This reduces the possible problem of the medicine sticking to the side instead of going into the air that you will inhale.

Wash in warm water and detergent then allow to drain dry. Do not rinse the detergent off with water.

It is important not to wipe the spacer dry with a tea towel or paper towel. If wiped dry the side of the spacer is likely to attract the medicine to stick to it rather than be in the air inside for you to inhale. Always leave your spacer to drip dry on a draining board or rack.

If your spacer has different cleaning instructions to above, follow the directions on the spacer. Check regularly for cracks or other problems. If used regularly the spacer may need to be replaced every 6 to 12 months.

Patient information:

• Follow the instructions on the label of the medicine or as directed by your doctor.
• Always shake the inhaler before use, whether using with or without a spacer.
• Do not spray more than one puff at a time into the spacer. If using two puffs, spray one first and inhale from the spacer, then repeat with the second puff.
• If possible use a mouthpiece rather than a face mask. This will avoid loss of the medicine in the nasal passages.
• Clean the spacer regularly and allow to drip dry.