How to Use Zerostat VT Spacer with Facemask in Older Patients
For older patients with difficulty using metered dose inhalers (MDIs), a Zerostat VT spacer with facemask should be used with a tight-fitting seal, allowing 3-5 slow breaths per actuation while maintaining proper positioning of the device. 1
Proper Technique for Using Spacer with Facemask
- Position the facemask to create a tight seal against the patient's face to minimize leakage, which is critical for effective medication delivery 2
- Actuate only one dose at a time into the spacer/valved holding chamber (VHC) per inhalation sequence 1
- Instruct the patient to take slow, deep breaths (30 L/min or 3-5 seconds) through the facemask 1
- Allow the patient to take 3-5 breaths per actuation to ensure complete inhalation of the medication 1
- Maintain the tight seal throughout the entire breathing cycle 2
Considerations for Older Patients
- Elderly patients often have difficulty using MDIs due to impaired cognitive function, memory loss, weak fingers, or poor coordination 1
- A spacer with facemask is specifically recommended for older patients who cannot use standard MDI techniques 1
- Be aware that using a facemask reduces medication delivery to the lungs by approximately 50% compared to a mouthpiece, so proper technique is especially important 1
- Consider anticholinergic medications in addition to β-agonists, as elderly patients' response to β-agonists declines more rapidly with age 1
Medication Selection and Monitoring
- When using anticholinergic medications, be cautious in patients with prostatism or glaucoma; consider switching to a mouthpiece if possible to reduce risk of acute glaucoma or blurred vision 1
- Monitor for tremor when administering β-agonists, as elderly patients are especially susceptible to this side effect 1
- For patients with known ischemic heart disease, the first dose of high-dose β-agonist may require ECG monitoring in a hospital setting 1
Spacer Maintenance and Care
- Rinse plastic spacers/VHCs once a month with a low concentration of liquid household dishwashing detergent (1:5000 or a few drops per cup of water) 1
- Allow the spacer to air dry without rubbing the walls to reduce electrostatic charge that can decrease medication delivery 3
- Do not substitute different spacers/VHCs as they are not interchangeable - each MDI-spacer combination should be considered a unique delivery system 4
Common Pitfalls to Avoid
- Poor mask-face seal is the most common reason for reduced medication delivery - ensure proper positioning and adequate pressure 2
- Actuating multiple doses into the spacer at once reduces medication delivery - use only one actuation per breathing sequence 1
- Breathing too rapidly prevents proper medication deposition - encourage slow, deep breaths 1
- Failing to maintain the spacer properly can lead to electrostatic charge build-up that reduces medication delivery 3
- Switching between different spacer brands can alter medication delivery and potentially reduce effectiveness 4