What are the advantages of a spacer device?

Metered dose inhalers, which are also commonly called “puffers or inhalers”, spray the medicine out so that you can breathe it deep into the lungs.

Inhaltsverzeichnis Show

How does a spacer help?
How to use your spacer
How to use a spacer AND mask
Regular cleaning
What is a spacer?
What are the benefits of using a spacer?
How to use a spacer
How to use a spacer and facemask with your baby
Looking after your spacer

Inhalers deliver medicine very quickly.

Inhalers are compact and light– so they can be easily taken with you wherever you go.

It’s very important to use your inhaler the correct way to make sure the medicine gets deposited in the lungs, where it works the best. Incorrect technique can leave some of the particles from the medicine on your tongue or throat, where it won’t help at all.

A spacer, or holding chamber, is an attachment that should always be used with your inhaler.

The spacer holds the medicine in place so you can breathe it in easier.

Now let’s demonstrate how to correctly use a spacer and mouthpiece.

First, remove the cap from the bottom of your inhaler.

When you get your new inhaler from the pharmacy, you need to “prime” or “waste” it by spraying the medicine into the air 4 times.

Now, fit your inhaler into the opening at the end of the spacer.

Shake the inhaler well for 10 seconds.

Turn your head to the side and breathe out.

Close mouth around mouthpiece of spacer.

Push down on the inhaler once. Now the medicine is inside the spacer.

Right away, take a slow, deep breath. The goal is to not hear a whistling sound. If you do, this means that you’re breathing in too fast.

Hold your breath for a count of 10.

Now, slowly breathe out.

Rinse your mouth out with water, or brush teeth, or get a drink after using controller medicines, such as inhaled steroids.

Many times, the correct dose of your medicine will be to inhale 2 puffs. If this is what is prescribed for you, then wait one minute after the first puff, and then follow all of the steps again.

Clean the plastic holder of the inhaler each week. For inhalers with a built-in counter do not remove the metal canister. Use a cotton swab to clean the opening where the medicine sprays out of the canister. For inhalers without a built-in counter, run warm water through it, shake off water and set overnight to dry.

Clean the spacer each week by soaking in warm soapy water for 15 minutes and run water through it, shake off water and set overnight to dry.

Remember if you have questions, call your doctor’s office, asthma care team or pharmacy.

Easy-to-read medicine information about spacers – what they are and how to use them.

Spacers are clear plastic tubes with a mouthpiece or mask on one end and a hole for your inhaler at the other. A valve in the spacer mouthpiece opens as you breathe in and closes as you breathe out. A spacer makes your MDI (metered dose inhaler) easy to use and more effective for people of all ages. Use your spacer with preventer, reliever, symptom controller and combination medicines.

Spacers are available free of charge from your doctor or respiratory educator.

How does a spacer help?

Advantages of using a spacer

Many adults and children are unable to use their metered dose inhaler effectively. The spacer reduces the need for perfect technique.
Spacers are designed to deliver up to twice the medication of an inhaler alone. 50% more medicine enters the lungs when a spacer is used.
Less medicine gets left in the mouth and throat, which reduces the side effects of hoarseness or thrush in your mouth from preventer medicine.
A spacer can help when you are short of breath and an inhaler by itself is difficult to use.
A spacer is a smaller, convenient alternative to a nebuliser.
Studies on adults and children show spacers work just as well as nebulisers in acute asthma.
Spacers with masks can help very young children inhale their medicine.

Read more about why should I use a spacer.

How to use your spacer

Source: eChamber spacer information

If you are unsure about how to use your spacer, ask your doctor, pharmacist or nurse. The following steps are a guide.

Remove the cap and shake the inhaler. Fit the inhaler into spacer opening (opposite the mouthpiece).
Put the spacer into your mouth ensuring that there are no gaps around the mouthpiece. Press the inhaler once only — one puff at a time into the spacer.
Breathe in slowly and deeply through the spacer mouthpiece and hold your breath for 5-10 seconds
OR take 2-6 normal breaths keeping the spacer in your mouth all of the time – You can breathe in and out with the spacer still in your mouth as most spacers have small vents to allow your breath to escape rather than going into the spacer.
If you need more than one dose of medication, wait one minute and then repeat these steps for further doses making sure that you shake your inhaler between doses
Wash your spacer once a week with warm water and dishwashing liquid. Don’t rinse. Drip dry. This reduces the electrostatic charge so that the medicine does not stick to the spacer sides
Check for cracks. If used regularly your spacer may need to be replaced every 12-24 months.

(Health Navigator NZ and Auckland District Health Board, 2018)

(Asthma Waikato, 2018)

How to use a spacer AND mask

If you are using a mask together with a spacer for your child place the mask on your child’s face, covering the mouth and nose ensuring there are no gaps. A mask is used for babies and infants that cannot seal their lips around the mouthpiece. Most children should be able to use the spacer without a mask by the age of 3 years. If you are using a mask with preventer medication wash the child’s face after use.

Regular cleaning

Wash your spacer once a week with warm water and dishwashing liquid. Check your spacer for cracks. If used regularly your spacer may need to replaced every 12-24 months.

Source: eChamber spacer information

Learn more

eChamber spacer information Apex Medical
What is a spacer? Asthma + Respiratory Foundation, NZ
Spacers - new brand funded Pharmac

Last reviewed: 10 Jul 2018 Page last updated: 03 Aug 2022

Many people have a hard time learning how to use metered dose inhalers correctly. Quite often, too much of asthma medicine ends up in the mouth and throat instead of passing into the lung's small airways where it is most needed to control the asthma symptoms. The result can be poor control of asthma, as well as side effects from getting the wrong dose of medicine, like sore throat, dry mouth, bad taste etc.

A spacer device is a large plastic container, usually in two halves that click together. At one end is a mouthpiece and at the other end is a hole for inserting the mouthpiece of an MDI.

The dose from your inhaler is sprayed into the spacer, from where it can be inhaled without needing to coordinate breathing and pushing down the inhaler canister.

There are several brands of spacer device available and they are all different (including Volumatic, Optichamber and Aerochamber). Each spacer device fits different inhalers and so it is important to get the right spacer device that fits your inhaler. The inhaler mouthpiece must fit properly into the spacer hole. Spacers are available on prescription.

In order to properly use an inhaler without a spacer, one has to coordinate a certain number of actions in a set order (pressing down on the inhaler, breathing in deeply as soon as the medication is released, holding your breath, exhaling), and not all patients are able to master this sequence. Use of a spacer avoids such timing issues. Spacers slow down the speed of the aerosol coming from the inhaler, meaning that less of the asthma drug impacts on the back of the mouth and somewhat more may get into the lungs. Because of this, less medication is needed for an effective dose to reach the lungs, and there are fewer side effects from corticosteroid residue in the mouth.

Valves on a spacer (which technically makes it a holding chamber) cause the patient to inhale the contents of the spacer, but exhalation goes out into the air. The problem of coordinating an inspiration with a press of an inhaler is avoided, making use easier for children under 5 and the elderly. It also makes asthma medication easier to deliver during an attack. So use of spacer is advised by many.

Health advice > inhalers, medicines and treatments > inhalers and spacers

Find out the benefits of using a spacer, how to look after your spacer, and how adults, children and babies can use them effectively.

On this page:

What is a spacer?

Spacers are empty tubes that are usually made from plastic. They slot onto the mouthpiece of your inhaler on one end, and you use a mouthpiece or mask on the spacer at the other end. They help you get the best from your asthma medicine if you use a metered dose inhaler (MDI).

If you’re using a dry powder inhaler (DPI) or a breath-actuated inhaler (BAI), you won’t need to use a spacer. Speak to your GP or asthma nurse if you’re not sure which type of inhaler you’re using.

Types of spacer

There are several different brands of spacer that fit different inhalers and are available on prescription (including Volumatic, AeroChamber, Able Spacer, Space Chamber Plus, and A2A spacer). Speak to your GP, asthma nurse or pharmacist about finding the right spacer for you. You can also buy a spacer from your pharmacy without a prescription.

What are the benefits of using a spacer?

Using a spacer with your metered dose inhaler (MDI) helps the right amount of medicine get to your lungs. Using a spacer will mean:

you may waste less medicine because it’s working more efficiently by getting the medicine straight to your lungs
you may reduce side effects from your preventer inhaler because less medicine is absorbed into the rest of your body - side effects like oral thrush are less likely because there’s less medicine in your mouth
you may find it easier to take your medicine because the medicine collects in the chamber of the spacer, and you can breathe it in without needing to get the timing and speed exactly right.

How to use a spacer

Your GP, asthma nurse or pharmacist should show you how to use your inhaler and spacer properly. You can also check your technique at your annual asthma review.

There are two breathing techniques for adults and children to use with a spacer: ‘tidal or multiple breathing’ and ‘single breath and hold’:

Both techniques work equally well. Multiple breathing may be prescribed to younger children as it’s easier to teach. Multiple breathing may also be prescribed if you’re having an asthma attack.

Top tips for adults using spacers

You might find it easier to be in front of a mirror to check your head is at the correct angle.
If you notice your spacer making a whistling sound, that means you’re breathing in too fast. If you need to take another dose, take the mouthpiece or mask away from your face, wait 30 seconds to a minute and shake the inhaler again. Then repeat the steps.
Make sure you’re making a tight seal with your mouthpiece or mask so that no medicine can escape.

Top tips for helping your child use a spacer

Sit your child on your lap, either sideways or facing away from you.
When you’ve finished, take the inhaler out of the spacer, and replace the caps on both.
If your child has used an inhaler that contains steroids, make sure they rinse their mouth out with water to help prevent side effects.
Take a look at our video on how to help your child use their inhaler and spacer.

How to use a spacer and facemask with your baby

Parents may find it easier to use a facemask with babies and younger children.

Watch our video for more advice on using a spacer with a facemask on your baby or child.

Top tips for your baby

If you have a baby or young toddler, sit them on your lap facing you so you can keep eye contact. With very young babies, you might find it best to tilt them back slightly.
Cuddle your baby on your knee or cradle them in your arms. Gently tuck their arms out of the way with one hand if they try to knock the mask away.
Be positive and smile! Your baby will be aware if you’re anxious.
Gently stroke your baby’s cheek with the mask so they get used to how it feels.
Reassure your child by pretending to take the medicine yourself or giving it to a favourite toy.
You can distract your baby with music or a video if it helps.

Looking after your spacer

Replacing and disposing of your spacers

You should replace your spacer at least every year, especially if you use it daily, but some may need to be replaced sooner – ask your GP, asthma nurse or pharmacist if you’re unsure.

Check the information leaflet that comes with your spacer to find out how to dispose of it. Spacers are not widely recycled so you may need to dispose of it in normal household waste.

If you’re using a spacer with rubber valves, replace it if the valves become stiff or brittle.

Tips for cleaning your spacer

If it’s a new spacer, clean it before you use it for the first time, then once a month afterwards.

Take your spacer apart and gently clean it with warm water and a detergent, such as washing-up liquid.
Only a small number of brands of spacer are dishwasher safe, so check the instructions on the label.
Use warm water instead of boiling water, as boiling water may damage the spacer.
Be careful not to scrub the inside of your spacer as this might affect the way it works.
Leave it to air-dry as this helps to reduce static (an electrical charge that builds up) and prevent the medicine sticking to the inside of the spacer.
When it’s completely dry, put your spacer back together ready for use.
Wipe the mouthpiece clean before you use it again.

When you’re not using your spacer, storing it properly will keep it in good condition, helping you or your child to get the best from your asthma medicine.

Don’t put your spacer in a plastic bag as this will cause it to build up static and reduce the effect of the asthma medicine.
Keep your spacer away from dust and liquids.
If you carry your spacer in your bag, keep it in a plastic-free sealed purse or small bag so it doesn’t get scratched, and so small objects don’t get stuck inside it.
You may find it useful to give your child a special plastic-free medicine bag or pencil case to keep their inhalers and spacer in. You could help them to decorate and personalise the case, so they are more likely to use it.

You can call our Helpline on 0300 222 5800 (9am - 5pm; Mon - Fri) to talk to a respiratory nurse specialist about using asthma spacers. Or you can WhatsApp them on 07378 606 728.

Last updated April 2021
Next review due April 2024