Using a spacer with your inhaler roughly doubles the amount of medication that reaches your lungs, from about 9% without a spacer to around 21% with one. The technique is straightforward once you learn it, but small mistakes in the process can significantly reduce how well your medication works. Here’s exactly how to do it right.
Why a Spacer Makes a Difference
When you use a metered-dose inhaler on its own, most of the medication (about 81%) lands in your mouth and throat instead of your lungs. A spacer is a tube or chamber that attaches to your inhaler and holds the medication in a cloud for a few seconds, giving you time to breathe it in at your own pace. This slows the spray down, breaks the particles into smaller droplets, and lets more of them travel deep into your airways where they’re actually needed.
The tradeoff is that some medication stays inside the spacer itself (roughly 56% of each puff). But because so much less coats your mouth and throat, the net result is still a major improvement in what reaches your lungs. Less medication in your mouth also means fewer side effects like oral thrush, which is common with inhaled steroids.
Step-by-Step Instructions
Before your first use, or if your inhaler hasn’t been used in several weeks, you need to prime it. Shake the canister vigorously about 10 to 15 times, then release three to four test sprays into the air, away from your face. This clears the valve and ensures the first real dose delivers the correct amount of medication.
Once primed, follow these steps for each puff:
- Shake the inhaler vigorously 10 to 15 times.
- Attach the inhaler to the spacer by inserting the mouthpiece into the open end of the chamber. Make sure it fits snugly.
- Breathe out fully. Exhale gently away from the spacer to empty your lungs as much as you comfortably can.
- Seal your lips around the spacer’s mouthpiece. Your lips should form a tight seal so no air leaks in from the sides.
- Press the canister once to release one puff of medication into the spacer.
- Inhale slowly and deeply through your mouth. A slow, steady breath is more effective than a fast gasp. If your spacer has a whistle or flow indicator, you’re breathing too fast when you hear it.
- Hold your breath for a count of 10, then exhale slowly.
If your prescription calls for a second puff, wait about 30 to 60 seconds, then repeat the entire process starting from shaking the inhaler again. Each puff gets its own full cycle.
The One-Puff-at-a-Time Rule
One of the most common mistakes is spraying multiple puffs into the spacer before breathing in. This actually reduces how much medication you get. When multiple doses sit in the chamber at once, the particles clump together and become too heavy to travel deep into your lungs. Research shows that lung delivery drops from about 21% with a single puff to around 15% when four puffs are sprayed into the spacer at once. Always spray one puff, inhale, hold, exhale, then spray the next.
Using a Spacer With Young Children
Children under age 5 typically can’t form a reliable seal around a mouthpiece or coordinate their breathing on command. For these kids, a face mask attachment connects to the spacer and covers the nose and mouth, creating a seal without needing the child’s cooperation. The mask should sit flush against the skin with no gaps. Once the puff is released into the spacer, let the child breathe normally through the mask for five or six breaths to inhale the full dose.
As children get older and can follow instructions to breathe in slowly and hold their breath, they can switch to using the mouthpiece directly, just like an adult. Most kids are ready for this transition around age 5 or 6.
Mistakes That Waste Your Medication
Beyond spraying multiple puffs at once, several other errors are surprisingly common. Not shaking the inhaler is a big one. The medication inside is a suspension, meaning the active ingredient and the propellant separate when sitting still. Without a vigorous shake, the first spray may deliver mostly propellant and very little actual drug.
Using an inhaler that’s nearly empty is another issue. As canisters run low, the doses become inconsistent. A good practice is to request a refill when your inhaler has about 30 puffs remaining, so you’re never relying on unreliable tail-end doses during an asthma flare.
Breathing in too quickly is perhaps the most intuitive mistake. It feels natural to inhale hard when you need medication, but a fast breath sends the particles crashing into the back of your throat instead of floating down into your lower airways. Think of it as sipping air, not gasping for it.
Cleaning and Maintaining Your Spacer
A dirty spacer doesn’t just harbor bacteria. It builds up static electricity on the inside walls, which causes medication particles to cling to the plastic instead of staying suspended in the air for you to breathe in. Proper cleaning eliminates this static problem.
Clean your spacer once a week and after recovering from any cold or respiratory infection. The process is simple: take the spacer apart if it has removable pieces, then wash everything in warm water with a small amount of liquid dish soap. Here’s the important part: let all the pieces air dry completely. Do not rinse off the soap residue, and do not towel dry. The thin soap film left behind reduces static buildup, and wiping with a cloth or paper towel reintroduces it.
Check your spacer regularly for cracks, discoloration, or damage to the one-way valve (if it has one). A spacer that’s cleaned properly and stays intact should last at least a year, often longer. Replace it sooner if the valve stops working, the plastic cracks, or the pieces no longer fit together tightly.
Checking Your Technique Over Time
Even if you learned proper technique when you first got your inhaler, habits drift. Studies consistently find that the majority of inhaler users develop at least one significant technique error over time without realizing it. If your medication seems less effective than it used to be, your technique is worth revisiting before assuming the drug isn’t working. Bring your spacer and inhaler to your next appointment and demonstrate your technique so it can be checked and corrected if needed.