Treatments and tests

How to use an inhaler (puffer) with small volume spacer

A spacer holds the spray from a puffer until it is all breathed into your lungs.  Everyone should use a spacer with their puffer.

Children under 3 need to use their spacer with a mask.

Many children by age 3 can start using their spacer without a mask.

Children over 5 and adults use an inhaler (puffer) with large volume spacer.

Why use a spacer?

Using a spacer means that much more of the medication gets down into the lungs compared to using the puffer without a spacer.

Spacers work just as well as a nebuliser (an electric device that converts liquid asthma medication into a fine mist) and they are cheaper and easier to carry around. Most children do not need a nebuliser at home.

Less of the medicine gets stuck in the mouth and throat when a spacer is used. This helps to cut down the risk of side effects in the mouth and throat such as thrush, hoarse voice and a sore throat when using steroid puffers.

Small volume spacer with a mask

Children under 3 need to use their spacer with a mask.

  1. Take the cap off the puffer.
    Cap being removed
  2. Hold the puffer upright and shake well.
    Puffer being shaken
  3. Place the mouthpiece of the puffer firmly into the end of the spacer. Attach the mask to the other end.
     Spacer being attached to mouthpiece of puffer with mask at other end
  4. Gently place mask over mouth and nose so that they are covered with no gaps around the edges.
     Child with mask over mouth and nose
  5. Press down on the puffer once and wait for your child to take 4 deep breaths in and out. (Watch the valve move with each breath.) Encourage mouth breathing which will increase medication delivery to the lungs.
     Hand pressing down on puffer with mask over child's mouth and nose

If a second dose is needed repeat steps 2–5.

Never spray more than one puff of the medication into the spacer at any time.

Small volume spacer without a mask

Many children by age 3 can start using their spacer without a mask.

  1. Take the cap off the puffer.
    Cap being removed 
  2. Hold the puffer upright and shake well.
    Puffer being shaken
  3. Place the mouthpiece of the puffer firmly into the end of the spacer.
    Spacer being attached to mouthpiece of puffer
  4. Place the mouthpiece of the spacer into your child’s mouth with lips closed firmly around it.
    Child with lips around spacer
  5. Press down on the puffer once and wait for your child to take 4 deep breaths in and out (watch the valve move with each breath).
    Hand pressing down on puffer with spacer in child's mouth

If a second dose is needed repeat steps 2–5.

Never spray more than one puff of the medication into the spacer at any time.

How should you look after a spacer?

Static electricity builds up inside a spacer. This makes the medication stick to the inside of the spacer, so not as much medicine goes down into the lungs.

To get rid of the static, spacers should be washed when they are first bought, and then every month.

  • Take the pieces of the spacer apart.
    end of spacer removed
  • Soak in warm soapy water for a few minutes. Use normal dish washing liquid.
    spacer in soapy water
  • Leave to drip dry.
    spacer draining on paper
  • Do not rub dry as this causes static.
    don't dry spacer with tea towel
  • Do not rinse the soap off. The soap will create a thin layer inside the spacer which helps prevent static.
    don't rinse spacer with water

Acknowledgements
Child and Adolescent Health Service

This publication is provided for education and information purposes only. It is not a substitute for professional medical care. Information about a therapy, service, product or treatment does not imply endorsement and is not intended to replace advice from your healthcare professional. Readers should note that over time currency and completeness of the information may change. All users should seek advice from a qualified healthcare professional for a diagnosis and answers to their medical questions.

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