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abominable snowman is holding a spacer and looks confused

Spacers: Fact & Fiction

While tidying up my medicine cabinet, I found a bag of clean spacers. Don’t even ask me how long they have been there, I would say a solid while, except for the one that I currently have in rotation for my rescue inhaler. I also found spacers abandoned in my home office, those ones had not been in use for some time.

What is a spacer?

A spacer is a plastic tube with a mouthpiece (this can be adapted for a mask) and a place to insert the inhaler on the other side.1 They can also be called (VHC) Valved Holding chambers.

Why a spacer?

They were developed from the concept that a class of medications used to treat asthma includes a class of prescription aerosol medications delivered by pressurized Metered Dose Inhalers (pMDI) “puffers”. Some of these medications are delivered aerosol at over 100 km per hour.5

The concern is that patients may not be getting the optimal amount of medication in their lungs.

Fact: spacers help with compatible asthma medication getting more efficiently into the lungs where it is needed. This is in response to the challenge of coordinating activating the pMDI when commencing inhalation.3 Spacers provide the patient with more time to accomplish this. Using these devices slows down the emitted particles from the pMDI, this may increase the lung deposition of fine particles, although the correlation is not well established.  These devices also reduce oropharyngeal deposition of the large particles.4

Are spacers only for children?

Fiction, although 1 in 5 people in an Asthma Society of Ireland study believe that they were only for children.1

Fact: Spacers can be for anyone that is using in a compatible medication. It is recommended that patients using a pMDI own a spacer, know how to clean them.6

A concern from the Irish study was access to spacers for school children using rescue inhalers in school, in particular, when exacerbations were induced by exercise, as a less reliable amount of medication was being delivered.1

Fact: Anyone with an inhaler device suitable for a spacer should use a spacer unless advised not to by their doctor.2

Do you need to prime the spacer before you use it?

Solid, maybe?

Researchers are still trying to figure this one out. There is some thought that priming (repeatedly firing aerosol from a pMDI into a  holding chamber without inhaling), may reduce the electrostatic charge of the inner wall of the spacer.  It is also expensive and wasteful of medications. It is thought that one or two doses after cleaning would be sufficient.7

Are you a spacer user? I would love to hear about your experiences.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

  3. Spacer devices for inhaled therapy: why use them, and how? Walter Vincken, Mark L. Levy, Jane Scullion, Omar S. Usmani, P.N. Richard Dekhuijzen, Chris J. Corrigan ERJ Open Research 2018 4: 00065-2018
  4. Newman  SP, Woodman  G, Clarke SW, et al.Effect of InspirEase on the deposition of metered-dose aerosols in the human respiratory tract. Chest 1986; 89: 551–55
  5. Newman S. Principles of Metered-Dose Inhaler Design, Respiratory Care, Sept 2005 Vol 50 No 9.
  7. Reducing electrostatic charge on spacer devices and bronchodilator response. Br J Clin Pharm 2000; 50: 277–280.


  • TracyLee
    12 months ago

    Dia, I read your article on spacers with great interest. When my asthma is triggered, my main symptom is coughing up buckets of mucus until the albuterol works its magic. Any eye-hand coordination I normally have is lost, and it is difficult to do a full inhale, not to mention holding it in a few seconds. For canister inhalers, a spacer has been essential and worth carrying the extra bulk wherever I go.

    If at some point you learn of a study that shows priming IS necessary to get a full dose, I hope you will do an article on this.


  • Leon Lebowitz, RRT moderator
    12 months ago

    Hi TracyLee and thanks for commenting on this article by our own Dia. Glad to see this material resonated so clearly for you in the use of spacers. Separating what is real from what is not, is always an important part of using one’s adjuncts when managing this condition. Again, we appreciate your input. Leon (site moderator)

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