Spacers – Making the most of your medication
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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!

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