Spacers – Making the most of your medication

I can almost feel the eye-roll from here. I know, I know: spacers are awkward shaped and bulky and don’t fit in my pocket and take up space and I’m not a little kid!
Look, I get it. Yes, the “spacer”, or valved holding chamber (more correct given what most patients actually use), are absolutely a design problem. Researchers get that, if you read to the last paragraph of this study. Unfortunately, however, your aerosol medication will still be delivered better, more consistently, if you use a spacer or valved holding chamber (VHC) device.

I have to know the why for everything. One day, I even resorted to attempting to take a slow-mo video of my inhaler firing (wasting a lot of Ventolin in the process…) to remind myself why I should use a VHC every time, not just with my daily (controller/maintenance) inhalers that contain inhaled corticosteroids. You can (more appropriately) do this experiment yourself with a spray bottle of water to roughly the same effect: the puff of aerosolized water (droplets or mist, whatever you’d like to call it) that comes out will be like an enlarged version of what your inhaler shoots out. You’ll notice that the mist is more concentrated immediately after being sprayed, than it is just a few centimetres away. Now, imagine the same thing when you stick an inhaler in your mouth: there’s only about 3-4 centimetres to work with in there before all that medicine hits the inside of your mouth of back of your throat if your inhalation is not perfectly timed or your angle is just a tiny bit off (or both). Inhalers themselves are a design flaw (which is why dry powder, breath actuated inhalers came into existence).

My friend John over at Respiratory Therapy Cave notes that you’ll get around 70% more medicine with using a chamber device, and that without one, only about 9% of meds from a metered dose inhaler might make it to your lungs—and that’s if you use it perfectly—which most of us don’t, especially not 100% of the time. And clearly, actually having the medication particles actually reach your lungs is super important to get your asthma under control and feel your best, but also—if you needed more motivation!—get your money’s worth from costly asthma medicines!

While there are a variety of types of valved holding chambers available, the most commonly used is the AeroChamber. While mask options are available for infants, kids, and adults who are unable to form a seal around the mouthpiece, it is often more effective to transition to a mouthpiece version, as medication can escape the mask if a complete seal is not made around the face. Many AeroChambers now also feature the Flow-Vu valve, allowing visual feedback of inhalation—important for caregivers to see that medication has been inhaled!
Here’s how to use an inhaler with a valved holding chamber:

  1. Shake inhaler well and remove the cap.
  2. Insert inhaler into the end of the chamber.
  3. Ensure the cap has been removed from the chamber.
  4. Place the chamber in your mouth, or firmly seal the mouthpiece over mouth and nose.
  5. Press down on the inhaler canister while inhaling slowly. The AeroChamber brand features a whistle that will sound if you are inhaling too fast!
  6. Best option: Inhale as deeply as possible slowly, then hold your breath for 10 seconds.
    Alternative method: Breathe in and out slowly into the chamber for about 5 breaths. (The one way valve on most chambers will redirect the meds to ensure the dosage is not getting blown away or diluted).
  7. If a second puff is required, wait 30 seconds to a minute, and repeat.

And remember, just because you might have previously tasted the medicine, not being able to when using a chamber is a GOOD thing—it means the particles aren’t getting trapped in your mouth and instead are getting to your lungs—a total bonus! While using a chamber, or spacer, has a couple extra steps, they’re well worth it to ensure your inhaled medicine is getting where it needs to go!

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

Comments

View Comments (31)
  • Norty
    6 months ago

    I just asked the question about spacers and now I have the answer. Thanks. Should have looked it up before.

  • lauren.tucker moderator
    6 months ago

    Thanks Norty. Glad you found your answer. We just published your question, feel free to comment below the question if you’d like to share your answer with us too. Thanks foe being here. We love when community members reach out! Best, Lauren (Asthma.net Team)

  • emmejm
    1 year ago

    It took me more than 20 years to give in, but I now carry my spacer everywhere with me and use it with my preventative medication. Trick of the trade: I keep my spacer and rescue inhaler in a small plastic baggie in my day bag so they don’t get all linty! Regularly using a spacer has definitely helped for me.

  • Lyn Harper, RRT moderator
    1 year ago

    emmejm – that’s great to hear! Better late than never is my philosophy. Have you given any thought to trying a collapsable spacer? It may not be for you and it sounds like you have a good system anyway, but they do take up less space and are easier to carry around. Just a thought…

    Regards,
    Lyn (moderator)

  • Leon Lebowitz, RRT moderator
    1 year ago

    Good for you, emmejm. Collapsible spacers may be perfectly suitable for you. Please check back and let us know what you think.
    All the best,
    Leon (site moderator)

  • emmejm
    1 year ago

    I didn’t even know collapsible spacers were a thing! I carry a large bag anyway, but I’m definitely going to look into that.

  • Kats
    1 year ago

    Great article, after reading this I will gind and use my spacers. Every time I am in the hospital I get one. Fortunately, I have been admitted only once in three years. Prior to that, it seemed like from October to May I ended up in the hospital for acute asthma flares. Finally, figured out my triggers and avoided or worked around them. Like leaving the house when my daughter in law vacuumed. Wearing a mask didn’t help in the house. Now my family sweeps instead of vacuuming

  • zionfrost
    1 year ago

    I am new to this site and I appreciate the topics and the blog. I have a cough-variant asthma which seems to be somewhat under control, but occasional I get the cough so bad I end up seeing the doctor and a Z-pack and a week of oral Prednisone takes care of everything. I just had one of those episodes PLUS I ended up with thrush, mainly in my throat/esophagus. My question is: do I need to discard my inhalers after having thrush because of self-contamination from my inhaler and spacer? Obviously I need to keep the spacer clean, but wondered about the inhalers themselves (which are pretty darned expensive with my current insurance plan.) Thanks so much in advance…

  • Leon Lebowitz, RRT moderator
    1 year ago

    Hi zionfrost and welcome. While we cannot provide medical advice over the internet (for your own safety), your inquiry certainly warrants a comment. In the most general of terms, the ‘thrush’ you’ve contracted is from not rinsing your mouth thoroughly after using the (steroid) inhaler. Normal cleaning procedures should be followed after each use. You probably do not have to discard the inhaler but it’s best for you to check with your physician and then follow his/her advice.
    Please check back with us and let us know how you’re doing.
    All the best,
    Leon (site moderator)

  • lenore
    1 year ago

    I have been using an aero chamber for about 3 years, ever since the powder in the discus gave me candida of the esophagus. I have been very happy with this delivery system & highly recommend it. I dont have to carry it around, as I take my Advair HFA, 2X a day (am & bedtime). No more hoarse voice, scratchy throat & downright unpleasantness of powder going down my throat. My drugstore (Walgreens) ordered one for me.

  • Leon Lebowitz, RRT moderator
    1 year ago

    Lenore – good for you. It’s so good to hear the success you’re having with Advair and your delivery system. You must feel pretty good about not having to deal with the previous side effects you described. Keep up the good work! All the best, Leon (site moderator)

  • janetg
    1 year ago

    Ok, ok, ok. After many months of not using a spacer (even though I have 2 of them), this article convinced me that the benefits of using a spacer are significantly higher than the benefit (I hate how bulky they are) of but using one. One of my spacers does whistle, so I guess I’ll use that one. Thanks for the good article! Sighs!

  • Leon Lebowitz, RRT moderator
    1 year ago

    Hi janetg and thanks for letting us know the value you found in our published article on spacers. I’m sure you’ll find that using one (especially the one with the whistle) is much more beneficial than not having one in place when you use your metered dose inhaler (MDI). All the best, Leon (site moderator)

  • LeahHorton
    1 year ago

    Good to read!

  • Leon Lebowitz, RRT moderator
    1 year ago

    Glad to hear that you found this to be so helpful, LeahHorton, and thanks for letting us know.
    All the best,
    Leon (site moderator)

  • Laurie
    2 years ago

    I am new to this site . I have to ask … where can I get the aerochamber ???? I wonder why my doctor has NEVER offered any information on it either 🙁 I want one !!! thanks . oh, and one more question . I have had Asthma my whole life ( in my 50’s ) and recently, in the last year … I get really dizzy when taking my rescue or maintenance inhalers . I am going to mention it to my doctor ( if i remember this time ) but do other experience that too ?? I never use to . thanks

  • Leon Lebowitz, RRT moderator
    2 years ago

    Hi Laurie and welcome. We’re glad you’re here. If you do a ‘Google’ search’ for the Aerochamber, you will see the manufacturer of the device is Monahan Medical. There are several ways you should be able to get one for yourself. You can ask your doctor to prescribe it and see if it’s reimbursable. You can ask your pharmacist how to secure one. You can reach out to the manufacturer to see if they have any programs for patients that would enable them to provide one for you. Or, you can check online and see if you can order one directly. Please check back with us and let us know how you’re doing.
    While we cannot provide medical advice over the internet (for your own safety), I believe dizziness is one of the side effects listed on the package insert of most metered dose inhalers. If your symptoms persist, or get worse, you definitely will want to advise your physician. Hopefully, you will also receive feedback from our community members as well.
    All the best, Leon (site moderator)

  • Cevilla
    2 years ago

    I am wondering if I understand the article correctly. Is she saying that it is good to use a spacer even with a rescue inhaler? I only use a spacer (an aerochamber) with my maintenance asthma medicine.

  • Leon Lebowitz, RRT moderator
    2 years ago

    Cevilla – a spacer can be used with a rescue inhaler, but it’s not necessary. You are the best judge as to whether you ‘need’ one. If, when using your rescue MDI, your peak flow improves, you may not need to use the spacer. It would probably be best if you were to discuss this with your physician.
    Please check back with us and let us know how you’re doing.
    All the best, Leon (site moderator)

  • Ruthdm
    2 years ago

    am not sure what you mean by spacers, I don’t think I have ever seen one unless that is the red tube thing that is on the emergency inhaler. could you post a picture of one? do you need a prescription to get it? thank you for your help!

  • Leon Lebowitz, RRT moderator
    2 years ago

    It’s our pleasure, Ruth. Please check back with us and let us know how you’re doing.
    All the best,
    Leon (site moderator)

  • Ruthdm
    2 years ago

    Thank you for your help.

  • Kerri MacKay moderator author
    2 years ago

    Hi Ruth,
    The requirement of a prescription will likely vary based on where you live. If you Google the “aerochamber” this is probably the most common type of spacer or valved holding chamber used, although there are several others.

  • Dreiterdover
    2 years ago

    I have found when using my rescue inhaler that I can actually feel it going deeper into my lungs and getting faster relief if I bend over my bed when I do it. A counter is too high to help so if your really in trouble try to bend way over at the waist to use it.

  • Leon Lebowitz, RRT moderator
    2 years ago

    Hi Dreiterdover and thanks for sharing ‘what works for you’ when using your recue inhaler. Remember, what works for one person may not work for another. Some asthmatics may find it even more difficult to breathe when bending over at the waist. For some people, that position may compromise the movement of their diaphragm, especially when having shortness of breath and/or difficulty breathing. It will be interesting to hear if any of our community members comment on this. Warm regards, Leon (site moderator)

  • Richard Faust
    2 years ago

    Kerri, thanks so much for the informative article. Maximizing medication makes both medical and economic sense! As this article (https://asthma.net/types/childhood/) notes, spacers have long been advocated for children, but are not just for kids anymore. “For children age 5 years and younger, the best choice is a pressurized metered inhaler with a valved spacer device … In fact, spacers should be used by people of all ages who use metered dose inhalers.” Thanks again for pointing out the value of proper medical device usage. Best, Richard (Asthma.net Team)

  • branfeld
    3 years ago

    Spacers make a world of difference for me when taking rescue meds. I try to carry one with me all the time.

  • Leon Lebowitz, RRT moderator
    2 years ago

    My pleasure, Kerri!

  • Kerri MacKay moderator author
    2 years ago

    Thanks for chiming in, Leon!

  • Leon Lebowitz, RRT moderator
    3 years ago

    Hi Branfeld. Appreciating what Kerri has said (thanks, Kerri!); ‘easier said than done’, you’ll still find it worthwhile to do whatever you need to do to make certain you have a spacer partnered with the rescue inhaler that you have with you. It insures you will get the most from each actuation at the time when you need it most.
    Thanks for sharing your experience with our online community.
    Best regards,
    Leon (site moderator)

  • Kerri MacKay moderator author
    3 years ago

    Same here, and though I’ve had small bags created for this purpose… Still easier said than done! 🙂

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