Remote Primary Health Care Manuals

Spacer devices for respiratory medicines

Well lit area.

Spacers are used with a puffer to

  • Increase the amount of medication deposited in the lungs
  • Reduce medication being deposited in the mouth and back of the throat
  • Reduce oral side effects — eg oral thrush, hoarse voice
  • Make it easier to coordinate the action of using a puffer and breathing in

Encourage for all users, especially children and the elderly. Spacer is as effective as nebuliser with less chance of cross infection

Attention

  • Everyone using a spacer needs to know how to make bush spacer — may save a life
  • Keep spacers of each size in clinic for people to practise with
  • Each puff is sprayed into spacer and inhaled before next puff — ie only spray 1 puff at a time into spacer 

All spacers (including bush spacers) should be

  • Primed before first use — reduces static charge on inside so medicine won't stick, works more effectively
    • Wash spacer in warm water with a little dishwashing detergent
    • Do not rinse
    • Leave to air dry
  • Maintained
    • Wipe mouthpiece/mask with damp cloth — daily or after each use
    • Wash in warm soapy water, don't rinse, leave to air dry — once a month and after respiratory tract infections
    • Don't wash more often or more medicine will stick to walls of spacer
    • Spacers should be checked every 6-12 months for cracks and faulty valves

What you need

  • Spacer — check best size for person, one they will use/carry with them
  • Person’s puffer/aerosol inhaler with prescribed medicine
  • Mask — tightly fitting face mask can be used with spacer for people who cannot form a close seal around the spacer mouthpiece — eg young children or people with cognitive impairment

What you do

Two methods

  • Single breath — one slow deep breath then hold
  • Multiple breaths (tidal breathing) — used if cannot coordinate actions and breathing (eg children) or during an acute flare-up

Single breath

  1. Take cap off puffer, hold upright and shake for 10 seconds — Figure 6.34
  2. Put puffer mouthpiece into hole in spacer — Figure 6.35
  3. Hold spacer horizontally (long ways) with one hand and puffer with other hand — Figure 6.36
  4. Seal lips around spacer mouthpiece or fit mask — breathe out gently
  5. Press puffer canister once only — Figure 6.37
  6. Breathe in slowly and deeply — Figure 6.38. Hold breath for 5 seconds or for as long as comfortable
  7. Remover spacer from mouth and breathe out gently
  8. Repeat steps for as many puffs as prescription says
  9. Take puffer off spacer, put cap back on puffer mouthpiece

Figure 6.34  

Shake puffer.

Figure 6.35  

Insert puffer into spacer.

Figure 6.36  

Hold spacer horizontally.

Figure 6.37  

Press puffer canister to release medicine into spacer.

Figure 6.38  

Breathe in medicine.

Tidal breathing (multiple breaths)

  • Follow steps 1–5 above 
  • Breath in and out normally for 4 breaths
  • Remover spacer from mouth and breathe out gently
  • Repeat steps if needed
  • Take puffer off spacer, put cap back on puffer mouthpiece

To make emergency bush spacer

What you need

  • 1 x 500–600mL plastic water or soft drink bottle — Figure 6.39
  • Scissors or soldering iron

What you do

  • Soften bottom plastic soft drink/water bottle in hot water

Figure 6.39  

Empty 600ml plastic water bottle.

  • Cut or melt hole the same size and shape as inhaler mouthpiece into bottom of bottle
  • Fit inhaler into hole — Figure 6.40
  • Use as above

Figure 6.40  

Insert puffer into bush spacer made from a 600ml bottle.