Do I Need To Use A Spacer With My Inhaler?

Is A Spacer Necessary With My Inhaler?

Dr. Mahler: The pharmacist at the local drug store told me that I should use a spacer with my inhalers. I am confused because Bevespi and ProAir inhalers, which I take for my COPD, seem to be working fine. I asked my nurse practioner about it, and she said that it wasn’t necessary. What are your thoughts? Judy from Chattanooga, TN Judy, Your question is quite common and can certainly be confusing. Here are brief responses to the following questions. What Is A Spacer? It is a tube or extension device which adds space and volume between the inhaler (called a pressured Metered-dose Inhaler; it is abbreviated pMDI) and the mouth. In practice, the correct name is a valved holding chamber (as shown below). It has one-way valves to contain, or hold, the aerosol until it is inhaled.
Valved holding chamber is a spacer

Valved holding chamber to use with pressurized metered-dose inhaler

How Do You Use a Spacer? ► Place the inhaler into the end. ► Breathe out completely away from the device. ► Put the mouth around the mouthpiece of the spacer and close lips. ► Press down on the top of the canister to release aerosol into spacer. ► Then, breathe in with a slow and steady effort. Fill your lungs with air. ► Hold your breath for as long as possible. ► If the device makes a whistle sound, you are breathing in too fast.
Actual use of spacer

Woman using valved holding chamber (spacer) with pMDI

What Are The Advantages Of A Spacer? The device slows the speed of the aerosol from the inhaler and also allows the size of the aerosol particles to be smaller. They also decrease the amount of aerosol that hits the back of the throat. However, studies have shown that there are no differences in breathing tests (lung function) comparing use of an inhaler (pMDI) with or without a spacer if the person uses good technique. What Are The Disadvantages Of A Spacer? They are larger and somewhat cumbersome compared with inhaler alone. They typically cost between $15 – 40. Your health insurance may or may not cover this expense. There is possible contamination if it is not cleaned as directed. When Should A Spacer Be Used? In my practice, I recommend using a valved holding chamber for two conditions: ► If you have difficulty with coordinating breathing and pressing down on the canister of the inhaler (pMDI) ► If the pMDI contains an inhaled corticosteroid If the inhaler has a corticosteroid, you should rinse your mouth with water, swish, and then spit the water out. This reduces the chances of a yeast infection in the back of your mouth (called oral thrush). Judy – as long as you use good technique with the two inhalers and they are working for you (making it easier to breathe), then a spacer device is not necessary. Best wishes, Donald A. Mahler, M.D.

Donald A. Mahler, M.D. is Emeritus Professor of Medicine at Geisel School of Medicine at Dartmouth in Hanover, New Hampshire. He works as a pulmonary physician at Valley Regional Hospital in Claremont, NH, where he is Director of Respiratory Services.