How to use a puffer with a spacer (also called a valved holding chamber)

It is recommended that you use a metered dose inhaler (also known as an "MDI" or "puffer") with a spacer (valved holding chamber).

A spacer is a plastic tube that holds the spray from your puffer (inhaler). You spray your puffer into the spacer, and then slowly inhale the air from the spacer. Using a spacer improves your chances of getting the more medicine into your lungs.

How to use a spacer with a mouthpiece

1. Remove the cap of the spacer.
2. Remove the cap of the puffer. Shake the puffer 5 or 6 times.
3. Insert the puffer in the hole at the back of the spacer.
4. Sit up with your back straight, or stand up.
5. Blow all your breath out until your lungs are empty.
6. Seal your lips around the spacer mouthpiece.
7. Press the down once on the puffer's canister – this will spray medication into the spacer.
8. Slowly breathe in from the spacer until you can't take in any more.
9. Hold your breath for as long as you can, (5-10 seconds).
10. Take the spacer mouthpiece out of your mouth, and breathe out normally.
11. If you need a second puff, wait one minute and repeat these steps.
12. Rinse your mouth out with water and spit the water out (don't swallow it). Rinsing your mouth can cut down on some side effects, like a white coating on your tongue (a yeast infection called thrush) or a sore throat.

How to use a puffer with a spacer that has a mask

Doctors recommend spacers with masks for children until they are able to understand the instructions on how to use a spacer with a mouthpiece. They also recommend spacers with masks for adults who can't keep their lips sealed around the regular spacer.

1. Remove the cap of the puffer. Shake the puffer up and down.
2. Insert the puffer in the hole at the back of the spacer.
3. Have the child sit up straight.
4. Put the mask over the child's mouth and nose. Press the mask against her face. Make sure there are no gaps between her face and the mask. Hold the mask on the child's face with one hand. With the other, hold the spacer, with your finger on top of the puffer's canister.
5. Press the puffer's canister down to spray one puff into the spacer.
6. Ask the child to breathe in and out through her mouth 6 times.
7. If your child needs more than one puff of medicine, repeat steps 5- 7. Do not spray more than one puff at a time into the spacer.
8. Rinse your mouth out with water and spit the water out (don't swallow it). Rinsing your mouth can cut down on some side effects, like a white coating on your tongue (a yeast infection called thrush) or a sore throat.

How to use a puffer (metered-dose inhaler) if you don't have a spacer

1. Stand up, or sit up with your back straight.
2. Remove the cap from the mouthpiece and shake the inhaler.
3. Breathe out normally.
4. Put the mouthpiece between your teeth, over your tongue. Wrap your lips around the mouthpiece.
5. Take a slow deep breath in. As you start to inhale slowly, press on the inhaler. Keep breathing in until your lungs are full. Now hold your breath for as long as you can, between 5 and 10 seconds.
6. Breathe out normally.
7. If you need a second puff, wait one minute and repeat these steps.
8. Rinse your mouth out with water and spit the water out (don't swallow it). Rinsing your mouth can cut down on some side effects, like a white coating on your tongue (a yeast infection called thrush) or a sore throat.

How to keep track of how many doses are left in your puffer (metered-dose inhaler)

To make sure you're getting the medicine you need, you need to keep track of how many times you've sprayed your puffer. It's the only way to know how many doses are left in your inhaler.

Some people try to shake the inhaler, float it in water, or taste it to see how much is left. None of these methods are recommended. The only way to tell how many doses are left in the inhaler is to keep track of the doses you've taken by writing them down. You can tape a piece of masking tape to the outside of the inhaler, and mark a line every time you take a dose. Or you can keep a notebook and pen in a bag with your inhaler, and record each dose in the notebook.

Look at how many doses are in your inhaler. Subtract the doses you've taken from the total doses. Once you've taken all the doses in your inhaler, stop using it. You may still hear some liquid swishing around in the puffer, but it won't be medicine. Inhalers have two ingredients in them: your medicine, which helps you breathe, and a propellant, which is there to push the medicine out. If you have some liquid left in your inhaler after you've taken all the doses, it's just propellant. If you take a puff of propellant, it won't help your breathing. In fact, it may make your breathing worse.

Important tips

It is recommended that you use a metered dose inhaler (also known as an "MDI" or "puffer") with a spacer. If you are in a situation where you need to use your MDI and have no spacer, it is important to learn how to use a puffer without a spacer.

Do not spray more than one puff at a time into the spacer.

Many spacers have a built-in whistle that will go off if you are inhaling too quickly. If you hear the whistle, inhaler slower.

Different companies make different models of spacers . Talk to a certified respiratory educator or your doctor about which spacer is best for you.

To learn more about your medication

Ask your pharmacist or your local Lung Association about where to buy a spacer.

Watch a video on how to use your puffer with a spacer.

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