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Greetings to all. I warmly greet everyone attending this presentation, "Using a Spacer with the Inhaler: A Guide for Elderly Adults with Asthma." A chronic respiratory disorder that damages the lungs' airways is called asthma. It is characterised by airway inflammation and constriction, which can cause recurrent attacks of wheezing, shortness of breath, chest tightness, and coughing. Asthma attacks or exacerbations are common names for these situations (World Health Organisation, 2023). This instructional session aims to provide elderly individuals recently diagnosed or already suffering from asthma with a solid understanding of the critical value of utilising a spacer alongside an inhaler.

Our overall health depends on breathing, and the elderly have a greater need for it. Therefore, today's discussion will centre on the many advantages of spacers, including improved medicine delivery and decreased adverse effects. Additionally, you will be led through a procedure in this presentation to ensure efficient and appropriate usage of spacers. After watching this presentation, the audience will be more equipped to care for their respiratory health, especially if they have asthma.

Why Use a Spacer?

Let us begin by addressing a fundamental question - "What is a spacer, and why should I use one?" A spacer is a device that attaches to the inhaler and plays a crucial role in enhancing medication delivery to the lungs (Gerald et al., 2022). This device is especially advantageous for elderly adults as it simplifies inhaling medication effectively.

Benefits of Using a Spacer

Improved Medication Delivery: As we age, our respiratory system may not function as efficiently as it did when we were younger. This is where a spacer proves invaluable for elderly adults. It ensures that a more substantial amount of medication reaches the lungs. The mechanism is straightforward yet remarkably effective (Sorino et al., 2020). A spacer acts as an intermediary, collecting the medication and allowing you to inhale it at your own pace. This gives the time to take a deep, slow breath, ultimately maximising the drug's effectiveness (Vincken et al., 2018).

Reduced Side Effects: Another significant advantage of using a spacer is reducing side effects. Some inhaled medications can end up in the mouth instead of reaching the lungs, potentially leading to side effects such as oral thrush. With a spacer, more medication is directed to the lungs, decreasing the amount that might land in the mouth (Anderson et al., 2018).

Types of inhalers

Metered dosage inhalers (MDIs), dry powder inhalers (DPIs), and soft mist inhalers (SMIs) are the three main types of inhalers used to provide drugs for asthma and chronic obstructive pulmonary disease (COPD) (Gerald et al., 2022). There are benefits and drawbacks to each type. Today, we will talk all about using a metered dose inhaler.

  • Metered Dose Inhaler (MDI): One of the most popular forms of inhalers is the meter-dose inhaler (MDI). Each actuation provides an exact dose of medication in aerosol form. The patient must use an MDI to time the inhaler's activation with their breath.
  • Dry Powder Inhaler (DPI): DPIs are devices that dispense medication pills. They don't need the same level of coordination that MDIs do while pressing the canister. Instead, the patient must inhale quickly and deeply to spread the powder throughout their lungs. DPIs frequently use breath actuation, which triggers the automatic release of medication as the patient inhales.
  • Nebulizer: A nebuliser is a device that produces a fine mist of medication to be administered. It is frequently used for kids or those with trouble utilising MDIs or DPIs. Nebulisers are frequently used at home or in hospital settings.
  • Soft Mist Inhaler (SMI): SMIs are more user-friendly than MDIs or DPIs since they release medication as a gentle, slow-moving mist. They are appropriate for people who have trouble inhaling quickly and forcefully.
  • Breath-Actuated Inhaler: This inhaler releases medication when you take a deep breath, so it doesn't require precise coordination.
  • Respimat: This soft mist inhaler makes it easier for some people to inhale medication by dispensing it as a slow-moving, fine mist.
  • Autohaler: An MDI having a built-in breath-actuated mechanism is known as an autohaler. When the patient inhales, the drug is released automatically.
  • Diskus: When a patient moves the lever to open the device, a Diskus releases the medication in a pre-measured dose. It is simple to use and does not require much coordination.
  • Turbuhaler: Another type of DPI, a turbuhaler loads the drug via a twist mechanism, and the patient inhales the powder (Healthify, 2023).

Advantages and disadvantages of MDIs

Metered Dose Inhalers (MDIs) are a widely used medication delivery method targeting respiratory conditions like asthma and chronic obstructive pulmonary disease (COPD). These devices offer several advantages and some drawbacks.

The portability and small size of MDIs, which make it easy for patients to carry and utilise them, is a key advantage. Each actuation releases a precise and constant amount of medication, guaranteeing exact drug delivery. Additionally, bronchodilators and corticosteroids are among the drugs found in MDIs, making them a flexible therapy choice. However, using MDIs presents several difficulties. For certain patients, especially kids and the elderly, it might be challenging to time the inhale with the actuation. By assuring improved lung drug deposition, spacer devices can assist in resolving this problem. Additionally, employing MDIs raises environmental issues because of the propellants they contain, which increase greenhouse gas emissions (De Boer & Thalberg, 2020). Other pros and cons are displayed in the table visible in front of you

 Priming the Inhaler

Step-by-Step Instructions for Checking the Inhaler: Before we delve into the specifics of using a spacer, ensuring that the inhaler is in good working condition is crucial. Let us go through some critical steps for preparing the inhaler:

Step 1: Start by removing the inhaler from its box or packaging.

Step 2: Remove the protective dust cap covering the mouthpiece.

Step 3: Give the inhaler a good, vigorous shake at least five times. It is essential to ensure the inhaler remains straight up and down while you shake it.

Step 4: Spray the inhaler into the air, away from the face. This helps ensure that the inhaler is primed for use.

Step 5: Shake the inhaler again before each priming spray for four sprays. This step guarantees the medication is adequately mixed and ready for inhalation (Denver Health, 2020).

Using the Spacer

  • Before using the inhaler, shake it.
  • Exhale completely.
  • Maintain appropriate inhaler positioning.
  • Puff the medication into your mouth while taking a deep breath, and then hold it for as long as you can (at least five seconds).
  • Between breaths, make sure to shake the inhaler (AsthmaWA, 2022).

To maximise the effectiveness of the spacer, it is crucial to ensure a good seal between the mouth and the spacer. A proper seal guarantees that the medication is directed toward the lungs and prevents escape (Health Direct, 2023).

Caring for the Spacer

Cleaning and Maintenance Tips: Regular cleaning and maintenance of the inhaler are crucial to ensure it functions correctly and remains effective. Always adhere to the cleaning instructions provided with the inhaler.

Proper cleaning and maintenance can significantly extend the life of the inhaler and help it work effectively. The goal is to prevent blockages or contamination that might impede lung medication delivery.

How to Clean and Maintain the Spacer: Caring for the spacer is as critical as maintaining the inhaler. Proper cleaning and maintenance are essential to ensure the spacer works effectively every time.

How to Clean the Spacer: After each use, clean the spacer by following these steps:

If the Spacer is made to be disassembled, do so. This makes thorough cleaning possible.

Warm, soapy water should be used to rinse all spacer parts. To get rid of any leftover medication, you must complete this procedure.

To get rid of any soap residue, properly rinse each component. Allow the spacer to thoroughly air dry after rinsing. Avoid using tissues or towels since they may contain fibres you do not want to breathe in.

People frequently make the error of not routinely cleaning their spacer. This may accumulate residue over time, decreasing the spacer's efficiency. As a result, include cleaning the spacer in your usual medication schedule to guarantee reliable, helpful use (Asthma + Lung UK, 2023).

Storing Inhaler

  • Safe Storage Practices: Proper storage of the inhaler and spacer is essential to ensure their effectiveness and safety. Here are some tips for safe storage:
  • Keep the cap on the inhaler: This prevents dust and debris from entering it, ensuring the individual does not inadvertently inhale foreign particles.
  • Maintain the correct temperature: Extreme temperatures or high altitudes can affect the medicine in the inhaler. Avoid leaving the inhaler in places that might become too hot or cold, such as in the car or on a sunny windowsill.
  • Keep the inhaler in a dry environment: Storing the inhaler in a bathroom, for example, can dampen the medicine, which can affect its efficacy.
  • Store all medicines safely: Store the inhaler and spacer out of reach of children and pets, as accidental ingestion or inhalation can have serious consequences (Asthma + Lung UK, 2023).


In conclusion, we have explored the many benefits of using a spacer with the inhaler. We provided comprehensive instructions on preparing and using the inhaler, offered maintenance tips to ensure their longevity, discussed loading the medication effectively, and emphasised safe storage practices. These insights are invaluable for maintaining and improving the respiratory health.

It is important to remember that managing respiratory conditions requires attention to detail and adherence to best practices, especially as we age. By incorporating a spacer and following the outlined guidelines, one can significantly enhance the effectiveness of the medication and minimise the risk of side effects.

Thank you for your attention, and we hope that the knowledge shared here empowers you to control respiratory health and ultimately leads to an improved quality of life. If you have any questions or concerns, please do not hesitate to seek guidance from the healthcare provider, as they are the most trusted resource for personalised care and advice.


AboutKids. (2023). Asthma: Using a metered-dose inhaler (MDI) with a spacer.

Allergy and Asthma Network. (2023). Asthma symptoms & triggers .

Anderson, G., Johnson, N., Mulgirigama, A., & Aggarwal, B. (2018). Use of spacers for patients treated with pressurized metered dose inhalers: focus on the VENTOLIN™ Mini Spacer. Expert Opinion on Drug Delivery 15 (4), 419-430.

Asthma Australia. (2021). It’s not just the puffer – Make sure you use a spacer for asthma control .

Asthma + Lung UK.(2023) Cleaning and looking after your inhaler.'t%20leave%20your%20inhaler,reach%20of%20children%20and%20pets.

Asthma WA. (2022). Asthma - Asthma WA

De Boer, A. H., & Thalberg, K. (2020). Metered dose inhalers (MDIs). Inhaled Medicines , 65-97.

Denver Health. (2020). How to prime an asthma inhaler.

E Surgery. (2023). How to clean a Ventolin and Salbutamol asthma inhaler .

Gerald, L. B., Dhand, R., & FRSM, A. (2022). Patient education: Inhaler techniques in adults (Beyond the Basics).

Health Clips. (2023). Step-by-Step: Priming Your Inhaler .

Health Direct. (2023). How to use an asthma inhaler .,the%20inhaler%20in%20between%20puffs.

Healthify. (2023). Inhaler devices .

Luke, s. (2023). Using an inhaler with spacer.

Sorino, C., Negri, S., Spanevello, A., Visca, D., & Scichilone, N. (2020). Inhalation therapy devices for the treatment of obstructive lung diseases: The history of inhalers towards the ideal inhaler. European Journal of Internal Medicine 75 , 15-18.

Very Well Health. (2022). Guide to over-the-counter inhalers for asthma.

Vincken, W., Levy, M. L., Scullion, J., Usmani, O. S., Richard Dekhuijzen, P. N., & Corrigan, C. J. (2018). Spacer devices for inhaled therapy: Why use them, and how? ERJ Open Research (2).

World Health Organisation. (2023). Asthma .

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