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Monday, May 19, 2014

What is a spacer?

The following was published on 12/15/11 on

What is a spacer? 

A spacer is a simple device that's proven to make an inhaler work better.  In fact, studies show they make an inhaler work 75 percent better, reduce side effects, and improve coordination.  Yet most asthmatics -- perhaps as many as 90 percent -- don't use one.

Albuterol inhaler with AeroChamber spacer
Most asthma rescue inhalers are metered dose inhalers.  This means that every time you squirt the inhaler you get the same amount of medicine squirted into your airway.  Yet one flaw with this design is the medicine is prayed so hard and fast into your mouth most of the medicine crashes into your upper airway instead of getting to your air passages.

A good way to test this theory for yourself is to take your inhaler, stick the mouthpiece into your mouth, and squirt it.  You'll notice that the spray hits you in the back of your mouth, producing a bitter taste.  Any medicine you can taste in your mouth is medicine that doesn't get to your lungs.  It's also medicine you swallow, and this causes systemic side effects.

Another problem many people have with inhalers is coordination.  Some asthmatics inhale too early.  some asthmatics inhale too late.  Most asthmatics inhale too fast, and this results in turbulence that causes the medicine to impact into your airway.  All of these coordination issues results in the medicine being less effective.

The spacer was meant to solve all these problems.  The concept was first thought up in the 1980s after various studies were done on the topic.  When I was a kid I was advised to use a toilet paper roll as a spacer.  This was a crude design, yet it worked.  

The idea is that the larger particles of the medicine will impact on the sides of the chamber instead of in your mouth.  The spacer also helps slow down the force of the spray so the medicine doesn't impact in your upper airway as much.  It also makes the inhaler easier to use, and improves coordination.

Ultimately pharmaceutical companies decided they could profit by the need for spacers, and now you can find many different designs of spacers.  My favorite is the AeroChamber.  A neat thing about it's design is if you inhale too fast the device will whistle.  In this way it teaches you inhale slow and smooth.

Another neat thing about the AeroChamber is you can squirt the medicine before you put the spacer into your mouth.  This works nice especially for the elderly and little kids who have trouble with coordination.

Using a spacer is pretty simple.  First you shake the inhaler, and then you insert the mouthpiece of the inhaler on the back end of the spacer.  Then you put your mouth on the mouthpiece of the spacer.  .  Just as you begin inhaling you squirt the inhaler.  You should then take in a full, deep and slow breath, and hold your breath for 5-10 seconds.

I like to advise my patients to not take their mouth off the mouthpiece until they are finished holding their breath.  After taking a first puff you wait 3-5 minutes before taking a second puff.  The first puff opens up your air passages and the second puff does the mop up job.

You can also place a mask over the mouthpiece, and this works nice for kids.  In fact, many studies show that using an inhaler with a spacer and a mask works better for young children than using a nebulizer.

Most asthmatics don't use a spacer because it kind of negates the major advantage of inhalers, that they are small devices that fit into pockets and purses.  Spacers are large and bulky and annoying.

For this reason most asthma controller medicines come come with new patented inhalers designed to maximize lung distribution.  The problem with these new designs is they make the inhalers more expensive.  

It's because of this reason -- cost -- that most rescue medicines -- like Albuterol -- don't come with some sort of built in spacer.  Since asthmatics must carry a rescue inhaler with them at all times, the spacer becomes an inconvenience.  Spacers don't fit in pockets.

Yet spacers work.  They usually cost about $10, but it's worth it.  The medicine will work better, it will last longer, and in the end you'll save money and your asthma will be better controlled.

So if you have an inhaler like Albuterol, I highly recommend you use a spacer with it. You can get one by asking your doctor to write a prescription.  In fact, you can actually just ask your pharmacist to give you one.  I've done it both ways. 

Or you can just use the crude method of a toilet paper roll if you prefer.

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Anonymous said...

The reason you wait to take another puff is not to let your aiways open up. You wait so the MDI has time to recharge the propellant it contains. You only need to wait thirty seconds or so.

john bottrell said...

Thank you for the clarification.  What you say is true.  For further information on this, check out this link.