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Asthma: Using a Metered-Dose Inhaler (MDI) with a Spacer

What is a metered-dose inhaler?

Many asthma medicines are given using a metered-dose inhaler (MDI). An MDI is made up of a metal canister inserted into a plastic holder. The metal canister contains the asthma medicine. When the canister is pushed down, it sprays a puff of medicine out. An MDI should be used with a spacer in order to get the dose of medicine into the lungs.

Metered-Dose Inhaler
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Young children cannot use an MDI properly by themselves. You will need to help your child.

Young children under the age of 9 usually cannot use an MDI properly by themselves. You will need to help your child.

What is a spacer?

A spacer slows down the medicine delivered from a metered-dose inhaler. This way the medicine stays in the spacer and your child can breathe it into her lungs. Without a spacer, the medicine sprays directly into your child’s mouth and throat, and less of it reaches the lungs. A spacer is also called an aerosol-holding chamber.

AeroChamber® and OptiChamber® are examples of a spacer.

You should try to give your child her inhaled medicine with a spacer whenever possible. This is the most effective way to deliver the medicine.

A spacer should always be used when your child is taking corticosteroid inhaler. When corticosteroid medicine is sprayed directly into the mouth, the medicine deposits in the mouth and throat. This can lead to irritation and sometimes infection (thrush) in the mouth.

Each child should have her own spacer. Do not share spacers with other children.

Spacers can be used with a mouthpiece or a mask

Depending on your child, you may give your child asthma medicine using a spacer with a mouthpiece or one with a mask. Younger children may need to use a spacer with a mask, because they may not follow instructions to seal their lips together when using a mouthpiece.

Spacer with Mask
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Depending on your child, you may give your child asthma medicine using a spacer with a mouthpiece or one with a mask. Younger children (under 5 years old) may need to use a spacer with a mask, because they may not follow instructions to seal their lips together when using a mouthpiece.

When your child is old enough to use a spacer with a mouthpiece, your child should switch over. A spacer with a mouthpiece delivers the medicine more effectively. Medicine can be deposited into the nose when your child uses a spacer with a mask. Using a spacer with a mouthpiece can prevent this from happening.

How to use a spacer with a mask

Follow the 4 steps below to give your child asthma medicine using a spacer with a mask.

Step 1: Collect the MDIs and spacer

  • Gather up the spacer and the metered-dose inhalers.
  • Insert the canister into the plastic holder if they are not already put together.
  • Take the plastic cap off the MDI.
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Step 2: Get ready

  • Put the MDI upright into the rubber hole of the spacer. The MDI should fit tightly into the hole.
  • Prepare your child by having her sit up or stand in a comfortable position.
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Step 3: Hold the mask to your child’s face

  • Hold the MDI and spacer together. Shake it 5 times.
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  • Put the mask firmly onto your child’s face. Be sure to cover the mouth and nose.

Step 4: Give the medicine

  • Hold the mask over your child’s face with one hand. Hold the spacer with the other hand and press the MDI down firmly with your thumb. This will release 1 puff into the spacer.
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  • Hold the mask over your child’s nose and mouth for 10 to 15 seconds. This should allow your child to take 6 breaths. You can also watch a valve move inside the spacer to count the breaths. Make sure your child takes deep breaths.
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If your child needs to take more than 1 puff of the medicine, repeat steps 3 and 4.

Step 5: Make sure your child rinses her mouth with water

  • Take the mask off your child’s face.
  • Wipe your child’s face. Let your child drink or rinse her mouth with water afterwards. This will remove the medicine left in the mouth to prevent thrush.
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How to use a spacer with a mouthpiece

A spacer with a mouthpiece is appropriate for children who can do all of the following:

  • hold their lips tightly around the spacer’s mouthpiece
  • breathe through their mouth only
  • hold their breath for 10 seconds

Usually, this means children older than 5 years.

Medicine can be deposited into the nose when your child uses a spacer with a mask. When your child is old enough to follow instructions, she should switch to a spacer with a mouthpiece.

Follow the 4 steps below to give your child asthma medicine using a spacer with a mouthpiece.

Step 1: Collect the MDIs and spacer

  • Gather up the spacer and the metered-dose inhalers.
  • Insert the canister into the plastic holder if they are not already put together.
  • Take the caps off the MDI and the spacer.

Step 2: Get ready

  • Put the MDI upright into the rubber hole of the spacer. The MDI should fit tightly into the hole.
  • Prepare your child by having him or her sit up or stand in a comfortable position.

Step 3: Give the medicine

  • Hold the MDI and spacer together. Shake it 5 times.
  • Ask your child to breathe out.
  • Have your child put the mouthpiece of the spacer between her teeth.
  • Ask your child to close her lips around the mouthpiece so no air can get out.
  • Press the MDI down firmly. This will give 1 puff into the spacer.
  • Ask your child to take one long slow breath, as deeply as possible.
  • Make sure the spacer does not make a whistling sound. If you hear a whistling sound, it means your child is breathing in too quickly. This will not allow your child to breathe in the medicine properly. Ask your child to breathe in more slowly.

Step 4: Have your child hold her breath

  • Ask your child to take the spacer out of her mouth.
  • Ask your child to hold her breath until you have counted to 10 slowly.
  • Ask your child to hold her breath until you have counted to 10 very slowly.
  • Have your child breathe out SLOWLY through her nose.

If your child has outgrown the yellow spacer with a mask but cannot hold her breath for 10 seconds, you may ask her to breathe in and out 5 times. This is not the best way to inhale the medicine, but it may help your child get used to using the mouthpiece. Keep working with your child to practice holding her breath for 10 seconds.

If your child has outgrown the yellow spacer with a mask but cannot hold her breath for 10 seconds, you may ask her to breathe in and out 4 to 5 times. This is not the best way to inhale the medicine, but it may help your child get used to using the mouthpiece. Keep working with your child to practice holding her breath for 10 seconds.

If your child needs to take more than 1 puff of the medicine, repeat steps 3 and 4. Make sure your child rinses out her mouth afterwards.

Sharon Dell, BEng, MD, FRCPC

Bonnie Fleming-Carroll, MN, ACNP, CAE

Jennifer Leaist, RN, BScN

Rishita Peterson, RN, BScN, MN

Gurjit Sangha, RN, MN

James Tjon, BScPhm, PharmD, RPh

1/29/2009




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