From the Guidelines
Using a spacer with a metered dose inhaler (MDI) is significantly more helpful than not using one, and it is strongly recommended for most patients. The benefits of using a spacer include increasing the amount of medication that reaches the lungs, reducing the velocity of the aerosol, and allowing larger particles to impact the spacer walls, leaving smaller particles that can penetrate deeper into the lungs 1. This is particularly beneficial for inhaled corticosteroids, as it reduces the amount of medication deposited in the mouth and throat, lowering the risk of side effects such as oral thrush.
When using a spacer, it is essential to inhale slowly and deeply immediately after activating the inhaler, and hold your breath for 5-10 seconds before exhaling. Spacers can enhance the bronchodilating effect of bronchodilators like albuterol or formoterol by ensuring more medication reaches the airways, which is especially important during asthma attacks when coordination may be difficult 1.
Some key points to consider when using a spacer include:
- Actuate only once into the spacer per inhalation
- Use a slow and deep inhalation technique, followed by a 10-second breathhold
- Rinse plastic spacers once a month with a low concentration of liquid household dishwashing detergent
- Consider using an antistatic spacer or rinsing a non-antistatic spacer with dilute household detergent to enhance delivery to the lungs
Overall, the benefits of using a spacer with an MDI, including improved medication delivery and reduced side effects, generally outweigh the minor inconveniences of added bulk and required cleaning, making them a valuable tool for patients using MDIs regularly 1.
From the Research
Benefits of Using a Spacer with a Metered-Dose Inhaler (MDI)
- Improves drug targeting by retaining large particles in the spacer and creating a prolonged aerosol cloud of fine particles, allowing for increased time to inhale after actuation 2
- Reduces the requirement to coordinate inhalation with actuation and improves inhaler technique in patients using a pressurized metered dose inhaler (pMDI) 2
- Enhances medication delivery to the airways, particularly in young children and the elderly 2
- Can be a cost-effective alternative to nebulizer delivery for acute asthma treatment 3
- May reduce the need for follow-up visits to the clinic and emergency department visits within 30 days 4
Comparison of MDI with Spacer to Nebulizer
- MDI with spacer can be as effective as nebulizer delivery for acute asthma treatment 3, 4
- However, one study found that nebulizer delivery resulted in greater spirometric improvement in patients with acute obstructive pulmonary disease compared to MDI with spacer 5
- The choice of MDI and spacer combination is crucial, as metering performance can vary significantly between different combinations 6
Important Considerations
- The shape and size of spacers can be inconvenient, but consideration of human factors and modern design may make them more attractive to patients 2
- Education on the proper use of spacers and MDIs is key to their acceptance by patients 2
- Regulatory agencies should approve MDIs to be used only with specific spacers/holding chambers that have been tested for metering performance 6