Asthma spacers 101: Do you need one?

Asthma spacers aren’t just for children. If you use an aerosol ‘puffer’ (sometimes called a metered dose inhaler or MDI), using an asthma spacer device can make a big difference to how much of your asthma medicine makes it into your lungs. Without a spacer, more medicine might end up in your mouth or throat, where it can cause irritation or infection (like oral thrush). It can also help if you have trouble with the proper technique for using a puffer where you have to coordinate the time of your breathing with pressing the puffer.

Whether you are using a preventer puffer or rescue medication (like Ventolin/Asmol), using an asthma spacer is an essential part of your asthma management toolkit.

(Note: This doesn’t apply to the dry powder type inhalers like Accuhalers, Turbuhalers, Elipta etc. For these inhalers, make sure you check your technique with your doctor or asthma educator. You can also watch videos showing the correct technique for different devices on the Asthma Australia website.)

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Who should use a spacer?

According to the National Asthma Council Australia, spacers should be used by:

• all children (young children under the age of 4-5 years should use a spacer together with a mask);
• all adults who use a corticosteroid preventer medication (such as Flixotide or Symbicort) using a puffer;
• adults who have trouble coordinating the ‘press and breathe’ technique when using an puffer;
• anyone having trouble breathing and taking a reliever medication (such Ventolin or Asmol) during an asthma attack.

If you are an adult currently using your inhaler without a spacer, you might think that this doesn’t apply to you. However, you might also be surprised to know that the majority of Australian asthma patients don’t use their inhalers correctly. If you don’t correctly time your breathing, the medication delivery isn’t as effective. Using an asthma spacer with your inhaler helps eliminate this timing problem and can really increase the amount of medicine that is getting into your small airways where it is needed.

I was once prescribed an inhaler to help with a persistent bronchitis and I have to admit, getting the timing right was hard. I much preferred using a spacer.

Did you know? “MDI’s with spacers are at least as effective as nebulizers” for treatment of asthma exacerbations in young children.

Harvey L. Leo and Benjamin J. Song
Pediatrics December 2017, 140 (Supplement 3) S218

Asthma spacer technique

The best way to learn technique is for someone to teach you in person. Your doctor or asthma educator should teach you how to use your spacer and inhaler. We also list links to some handy videos on correct technique at the end of this post.

If you are using a large volume spacer you may need to assemble it first.

You should shake the puffer first before inserting it into the spacer. Some spacers have a rectangular shaped hole and only work with compatible inhaler types. Other spacers have a flexible rubber opening which fits different shaped inhalers.

For small children (or anyone with trouble breathing), you can also use the spacer together with a mask which fits over the mouth and nose. This attaches to the mouthpiece end of the inhaler.

It is best to hold the spacer horizontally and tilt your chin slightly upwards when using it to help open up your airways. Breathe out away from the spacer first, put the mouthpiece into your mouth and close your lips to form a seal, and press your puffer to release one puff of medication. Breathe in at the same time. (If you wait too long, the medicine might fall to the bottom of the spacer).

Breathing in

There are two different ways to use your spacer when breathing in:

• Single breath – dispense one puff of medicine into the chamber and take one deep breath in and hold this for at least 5 seconds or longer.
• Tidal breathing – dispense one puff of medicine into the chamber and breathe normally, usually 4 times, in and out.

We use the second method as it is easier for our child to manage. I actually use it too. It can also be easier for someone experiencing shortness of breath in an asthma attack. Ask your doctor which method you should be using.

The important thing is to only dispense one puff of medication into the chamber of the spacer at a time. If you do more than one, the medication will stick together and fall to the bottom of the spacer and won’t be inhaled. If you need more than one dose, you should breathe out and then start the process again for the second (and any further doses).

Different types of spacer

Asthma inhaler spacers come in different shapes and sizes.

Large volume spacers (like the one shown in the photo above) usually come in two pieces and need to be assembled before use. A well known brand is Volumatic.

Other smaller volume spacers are fully assembled with a cylindrical chamber. They have valves so that you can see (and sometime hear by a whistling sound) that the air and medication is being inhaled. This is the type of spacer we use. (In the UK and Europe this type is sometimes called an “inhaler chamber”). They are often made in smaller volume sizes for children and larger ones for adults. We find a chamber style spacer easier for our child to hold and manage. You can shop for chamber style asthma spacers for adults and children (with masks) on Amazon.

It’s ok to use a full size spacer at home, but what about when you are out and about? Compact asthma spacers, where the inhaler/puffer can be stored inside the chamber to save space in your emergency kit, are ideal. Some are even collapsible. We have always used an Able Spacer (TM) for our portable medicine kit, and have just ordered one of their new collapsible, pocket size antibacterial spacers for our next replacement.

You can also get single use cardboard spacers. These could be a good option if you rarely use your inhaler. Because they are single use and disposable, they’d also be perfect for first aid kits.

Caring for your asthma spacer

You will need to keep your spacer clean to make sure that it works properly and medication doesn’t stick to the sides or the valve. There is a correct way to do this.

Asthma spacers don’t need to be cleaned as often as you may think. You should clean it before the first use and after that only about once a month.

Wash the spacer in clean warm water with normal dishwashing detergent. (I wash it when I am doing the dishes, but just make sure it is the first item I do.) The important thing is to then let the spacer air dry. Don’t rinse it and don’t dry it with a tea towel or paper towel. If you do, this can cause static and the medicine might stick to the sides of the chamber and it won’t make it into the lungs.

In between monthly cleans, you can still wipe the outside of the mouth piece to keep it clean and hygienic.

Make sure that you check your spacer (or ask your pharmacist to) to make sure that it doesn’t have any cracks and the valve is working properly. If it is damaged you will need to get a replacement straight away. We replace our spacers about every 12 months because they are used every day for preventer medication.

More information

Make sure that you speak to your doctor or asthma educator about how you you should be using your asthma inhalers. Ask them to watch you and check your technique. Using your inhaler devices correctly is so important to asthma management.

For more information, visit:

• Asthma Australia (including useful videos on how to use different asthma devices and inhaler techniques)
• National Asthma Council Australia (see the how-to video library showing the right technique for the main types of asthma inhalers, with and without spacers)

Another must have tool for managing your asthma is a written asthma action plan. And if you have asthma, don’t forget to include this in the medical ID information on your phone in case of emergency.

You might also be interested in reading our post about the benefits and limitations of using pulse oximeters to manage your asthma or about the risk of thunderstorm asthma for people with allergies.

*Disclaimer: Allergy Spot does not provide medical advice. You should always consult a suitably qualified medical practitioner in respect of your own medical conditions, symptoms or concerns. See our Website Terms for more details.