The False Security of Using a Spacer

Many of us with asthma use a spacer with our inhalers, with the assumption that the spacer ensures we get the full dose of medicine. But is this true?

The purpose of using a spacer.

Using a spacer or valved-holding chamber (VHC) with your metered dose inhaler (MDI) is important for many reasons. First, the spray from the inhaler shoots out big droplets of medicine at around 50+ miles per hour. Using a spacer or VHC slows the medication down while giving it “space” for the droplets to become smaller. It’s easier for these smaller droplets to make it deep into your lungs where the medicine is needed most. Second, the spacer or VHC will hold the medicine for a few seconds, eliminating hand/breath coordination issues, and giving you more time to inhale the medicine.

Ok - so those are all the things a spacer or VHC can help with it. But it’s important to know that even when using these devices, you still need the correct inhalation technique in order to get all of the medicine.

An inhalation technique for each inhaler.

Asthma inhalers include two main parts; the medication and the delivery device. There are many types of delivery devices, MDI’s, Diskus, Respiclick, Flexhaler, Ellipta, and Respimat. The goal of creating new delivery devices is to make inhaling the medication easier. Some inhalers (such as an MDI) require a slow, steady inhalation for 5 - 7 seconds. Others, such as dry powder inhalers (DPIs) require a deep, fast inhalation for 3 seconds.

The truth is, not everyone can master the different inhalation techniques, and a spacer doesn’t always help. In fact, a recent study published in The Journal of Allergy and Clinical Immunology: In Practice, found no evidence that spacer use led to an improved effectiveness of inhaled corticosteroids (ICS) delivered using a metered-dose inhaler. The authors called for additional research to better understand and confirm their findings. They emphasized the importance of patient education on inhaler technique, whether or not a spacer is prescribed.¹

The spacer does not necessarily ensure we will use our inhalers correctly, and education on inhaler technique is important. So, how do you learn and measure the correct inhalation technique?

Learning correct inhalation technique

Here are two devices I use to teach people with asthma the correct inhalation technique.
My go-to is the InCheck Dial. This simple-to-use, handheld, tube-shaped device simulates inhalation for every inhaler currently on the market with assorted mouthpieces and settings. After choosing the setting and mouthpiece for the inhaler you want to learn, simply inhale as you normally would when using your inhaler. There’s a disk inside the device that starts at the bottom, and based on how hard and long you inhale, the disk will move inside the tube. When your inhalation is complete, the disk will land somewhere on the scale posted on the side of the dial. This scale will show if you inhaled too quickly, too slowly, or just right. You can keep practicing until you get it the inhalation technique correct.

The second tool I use in my asthma education classes is the Aerosol Inhalation Monitor (AIM). The AIM is an electronic device that simulates an MDI and DPI inhaler. A series of lights and beeps guides you through the inhalation process, how long to hold your breath, and when to exhale. With lights on a diagram of lungs, the device shows you where the medicine landed based on your inhalation; the back of your throat, your upper or lower lungs. The goal is to get the medicine into your lower lungs where it’s most needed. You can keep practicing until you master the inhalation technique.

Asthma medication is expensive and can be life-saving. It’s important that you get the full dose of medication when you use your inhaler. Ask your healthcare provider if they have the InCheck Dial, AIM, or other tools available to ensure you have the correct inhalation technique.

Have you used any of these of devices? Tell us about your experience in the comments.