If you are using a puffer to take your asthma medication, you should always use a spacer as well, regardless of whether you are taking your daily preventer or using your blue reliever during an emergency.
A spacer is a clear plastic container shaped like a football or a tube with a mouthpiece or mask at one end and a hole for an inhaler at the other. Spacers help to get asthma medication into your lungs. The medication is ‘fired’ from the puffer into the spacer device and is then inhaled through the mouthpiece or a face mask.
Note: Spacers can only be used with ‘puffer’ style inhalers.
Why should I use a spacer?
Spacers are beneficial to use with your puffer because:
- More medication gets into your lungs than if you use a puffer on its own.
- They reduce the local side effects of inhaled steroids in preventer medications, because less of the medication sticks in your mouth and throat
- You don’t need to coordinate pressing your puffer and breathing in at the same time
- Reliever medication via a spacer is at least as effective as via a nebuliser in an asthma attack, and you can take the medication faster and in a lower dose than with a nebuliser. This is because the spacer delivers the medication more effectively. This lower dose reduces the risk of side effects such as fast heart rate and tremor which can be caused by the reliever
How does a spacer work?
When medication is ‘fired’ from a puffer into a spacer, a lot of it ‘floats’ in the chamber of the spacer. You can then breathe the medication into your lungs directly. Spacers also have a one-way valve that allows you to breathe out into the mouthpiece or mask, but the medication is not blown out of the spacer.
Note: If you ‘fire’ medication from a puffer into your mouth without using a spacer, the medication comes out very fast, and lots of it hits the back of your throat and mouth. This causes more local side effects such as oral thrush when using inhaled steroids. Using a puffer also doesn’t get medication into your lungs as effectively as using a spacer.
Who should use a spacer?
Spacers are particularly recommended for:
- Anyone taking a corticosteroid preventer
- Adults who have trouble coordinating the timing of pressing and breathing in that you need to take a puffer
- All children under 8-10 years taking inhaled medications. Children older than this can usually take reliever medication through a puffer when they are relatively well (e.g. before exercise) but should still use a spacer for reliever medication during an asthma attack or with a corticosteroid preventer
- Anyone having an asthma attack
Which type is best?
There are a range of spacers available, in different shapes, sizes and colours. There are two main differences: large volume and small volume.
Large volume spacers are an oval shape, and are bigger. One of the most common ones is the Volumatic spacer. These should be used only for adults or children over five years old, as younger children aren’t able to take deep enough breaths to empty the spacer out.
Small volume spacers are usually shaped more like a tube, or a cone. They are more convenient because they are smaller and so fit into handbags and schoolbags more easily. Children under five should use a small volume spacer. Many older children and adults also use small volume spacers because they are more portable.
Note: Young children should use a face mask with their spacer (as they have trouble sealing their lips around a mouthpiece), but once they are over about two years of age you can start to introduce them to using a mouthpiece instead, depending on what they are comfortable with. Using a spacer with a mouthpiece means less of the medication gets stuck in the nose, so more goes into the lungs.
Will my puffer work with any spacer?
Check what sort of puffer you have before you buy a spacer – some of them only fit certain shapes of puffer. If you would like to use a spacer but have been prescribed an accuhaler or a turbuhaler (which cannot be used with a spacer) you can speak with your doctor to find out if your medication is available in a puffer.
Note: There are a few types of spacers that are ‘disposable’ which means they are made only to last a short time and cannot be cleaned. They may be made from plastic or paper, and are usually used in hospitals or clinics where they have to throw the spacer away after one person has used it. You can still use these types, but do not use them for any longer than advised by the manufacturer, as it will not work as well after a period of time.
Where do I get one from?
Your local pharmacy may stock a range of spacers. Prices start around $12. You might want to get an extra one to have at work, or to leave with your child at school or childcare.
Note: OATSIH-funded Aboriginal and Torres Strait Islander Health Services can purchase low cost spacers through the Aboriginal Spacer Ordering System.