How to use a spacer with an pMDI (Medical Students)

Children should always use a spacer with their inhaler:

1. Easier to use (no synchronisation is needed).
2. Increase delivery of the medication to the lungs.
3. Reduce the risk of side effects from ICS (oral thrush and hoarseness).

There are two ways to take the inhaler - the 'single-breath and hold' and the 'tidal breathing' techniques (the latter is preferred for children).

Prime the inhaler if it is new or has not been used for more than a week.

The one-way valve in the spacer device regulates inspiratory flow and prevents exhalation into the device. 

How to use a pMDI with a spacer device:

1. Remove the cap, and attach the inhaler to the spacer.
2. Shake the inhaler well.
3. Grip the mouthpiece gently between teeth, and close lips around it. If the child is using a spacer with a mask (usually less than 6 years) place the mask over the child’s mouth and nose, making sure there is a good seal.
4. Press the inhaler once to release one puff in the chamber.
5. Have the child breathe in and out 5 times (or for about 15 seconds in younger children). The movement of the valve indicates that the technique is correct.
6. Shake the inhaler again and repeat steps 2-5 if more than 1 puff has been prescribed.
7. Unhook the inhaler from the spacer and replace the cap.
8. Rinse the mouth with water when using a corticosteroid to prevent oral thrush.

In short, (1) shake, (2) spacer, (3) tidal breathing.

Cleaning the Spacer

The spacer should be cleaned weekly. Take the spacer apart and wash it in warm soapy water. Do not rinse. Allow the spacer to drip dry. Do not wipe the spacer dry with a towel to avoid static electricity.

Shaking

Flocculation—the aggregation of suspended drug particles into woolly clumps—occurs rapidly by design in pMDI both for SABA and ICS. Hence the need for vigorous shaking of the pMDI before use to disperse the particles and mix well with the propellant. See the figure below.

Videos

Watch relevant videos from Asthma UK - link.