Managing asthma or COPD often involves using a metered-dose inhaler (MDI) – commonly called a “puffer.” Using an MDI with a spacer (also known as a valved holding chamber) can make it easier to get medication into your lungs effectively. In this guide, we’ll explain what MDIs and spacers are, why a spacer is beneficial, and provide clear, step-by-step instructions (with visual ideas) on how to use your inhaler with a spacer. We’ll also cover common mistakes to avoid and tips on caring for your spacer to ensure you get the most from your medication.

What Is an MDI and What Is a Spacer?

Metered-Dose Inhaler (MDI): An MDI is a handheld inhaler device that delivers a specific measured dose of medication in a mist (aerosol) form to your lungs. It consists of a small pressurized metal canister fitted into a plastic sleeve with a mouthpiece. Each time you press down on the canister, it releases a “puff” of medicine. Many MDIs have counters to show how many doses are left. MDIs are commonly used for asthma and COPD medications, including bronchodilators (for quick relief) and inhaled corticosteroids (for daily control).

Spacer (Valved Holding Chamber): A spacer is an add-on chamber that attaches to your MDI’s mouthpiece. It’s usually a plastic tube with a mouthpiece on one end (or mask) and a slot on the other end where the inhaler inserts. When you press your inhaler, the spacer holds the medication mist suspended in the chamber for a moment, giving you time to inhale it slowly with repeated breaths. In short, the spacer makes using an inhaler easier and more effective by eliminating the need to perfectly coordinate pressing the inhaler and breathing in at the same time. You can inhale the medicine by taking a few normal breaths – the one-way valve in the chamber keeps the medication from escaping until you breathe it in.

Why use a spacer? Using a spacer greatly improves the delivery of medication to your lungs. Without a spacer, much of the medicine can hit the back of your throat or tongue and never reach the airways. With a spacer, more medicine goes straight into your airways (lungs) where it’s needed. This not only makes the inhaler more effective, but also reduces side effects. For example, a spacer helps prevent yeast infections in the mouth (thrush) and hoarseness that can happen with inhaled steroids, because less medicine sticks in your mouth. It also reduces the amount of medicine you swallow, which means fewer systemic side effects. Spacers are especially recommended for inhaled corticosteroids and for anyone who has trouble timing their breath with pressing the inhaler. (Note: Spacers are only used with MDIs – dry powder inhalers (DPIs) should not be used with a spacer.)

Step-by-Step: How to Use Your Inhaler with a Spacer

Using an MDI with a spacer is simple with practice. Below is a step-by-step guide for adults, with each step explained. For each step, we’ve also included ideas for visuals (diagrams or photos) that could help illustrate the technique.

1. Check Your Inhaler and Spacer: Visual idea: Image of an inhaler showing a dose counter and expiration date. Before you begin, check the dose counter on your inhaler (if it has one) to ensure it isn’t empty, and look at the expiration date. Do not use an inhaler that reads “0” doses or is past its expiry – if it’s empty or expired, you won’t get the medicine you need. Ensure the spacer has no cracks and is clean and dry.
2. Prepare the Inhaler and Spacer: Visual idea: Photo of removing the caps from the inhaler and spacer. Remove the caps from both the MDI and the spacer’s mouthpiece. Make sure the mouthpiece and spacer are clean and free of any loose objects or debris that could be accidentally inhaled.
3. Shake the Inhaler (and Prime if Needed): Visual idea: Person shaking the inhaler vigorously. Hold the inhaler upright and shake it well for about 5–10 seconds. This mixes the medication inside. Priming: If it’s the first time using a new inhaler.
4. Attach the Inhaler to the Spacer: Visual idea: Diagram of inhaler being inserted into spacer. Insert the mouthpiece of the inhaler firmly into the hole on the back of the spacer. The inhaler should fit snugly in the spacer. Keep the inhaler-spacer unit upright (spacer horizontal) as you use it.
5. Sit or Stand Upright: Visual idea: Patient sitting up straight, head slightly tilted back. Good posture helps the medicine flow correctly. Sit up straight or stand. If standing, keep your back straight; if seated, try not to slouch. It can also help to lift your chin slightly so your head is tilted back a little, which opens your airway.
6. Exhale Fully Away from the Spacer: Visual idea: Person exhaling to the side, away from device. Before using the inhaler, breathe out fully to empty your lungs. Take a normal exhale away from the mouthpiece (not into the spacer) so that your lungs are ready to inhale the medication. Pushing out as much air as you can will make room for the medicine-rich air you’re about to breathe in. (Many people forget this step – don’t skip it, as it’s been noted nearly 69% of patients fail to exhale fully before inhaling, which reduces the effectiveness of the next breath.)
7. Seal Your Lips Around the Spacer Mouthpiece: Bring the spacer’s mouthpiece to your mouth and close your lips firmly around it. Ensure a tight seal with your lips so no air escapes and no outside air gets in. Don’t bite the mouthpiece – just rest it between your teeth and seal with your lips. Visual idea: Close-up photo of mouth sealed around the spacer’s mouthpiece properly. Keep your chin up and the spacer level.
8. Press the Inhaler and Inhale Slowly: Press down once on the top of the inhaler canister to spray one puff of medication into the spacer. As you press the inhaler, begin to breathe in slowlythrough your mouth, drawing the medication from the spacer into your lungs. Continue slow and deep breathing for about 3-4 breaths to get all the medication in from the one puff (If the spacer makes a whistling sound, it means you’re inhaling too fast; slow down your breath)
9. If You Need a Second Puff, Wait and Repeat: Press down a second on the top of the inhaler canister to spray a second puff of medication into the spacer. As you press the inhaler, begin to breathe in slowlythrough your mouth, drawing the medication from the spacer into your lungs. Continue slow and deep breathing for about 3-4 breaths to get all the medication in from the second puff.
10. Rinse Your Mouth (If Using a Steroid Inhaler): If your medication is an inhaled corticosteroid (such as fluticasone, budesonide, etc.), rinse your mouth out with water after you finish and spit it out. This step helps prevent thrush (a white yeast infection in the mouth) and throat irritation. Visual idea: A glass of water and a person gargling. For bronchodilator (reliever) inhalers, rinsing is not necessary, but it won’t hurt – it’s mainly important for steroid (preventer) inhalers.
11. Replace Caps and Store the Devices: Once you’re done, put the cap back on the inhaler and on the spacer. Store them in a cool, dry place, away from extreme heat or cold. Avoid leaving your inhaler in a hot car or freezing temperatures, as this can affect the medication. Keep your inhaler and spacer together so you always remember to use them as a pair.

By following these steps, you ensure that you get the maximum benefit from your inhaler medication. Take your time with each step – it gets easier with practice. If you’re ever unsure, ask your healthcare provider or pharmacist to watch your technique and give feedback.

Common Mistakes to Avoid

Even experienced patients can slip up on inhaler technique. Studies have shown a majority of adults make at least one error when using MDIs, especially without spacers. Here are some common mistakes to avoid when using an MDI with a spacer:

• Not using the spacer or not attaching it correctly: Always attach the inhaler firmly to the spacer before use. In one review, the single most common error (seen in ~74% of patients) was failing to attach the inhaler to the spacer properly. The spacer is what makes the medication delivery more efficient, so skipping it or a loose connection defeats the purpose.
• Forgetting to shake or prime the inhaler: Make sure to shake the inhaler well before each puff to mix the medicine. Also, prime new or long-unused inhalers by spraying a couple of test puffs into the air. Not doing so can result in too weak or too strong a dose. (Roughly 38% of patients in one study didn’t shake their MDI, an important step for proper dosing.)
• Not exhaling first: Always exhale fully before you inhale the medication. Skipping this means you’re trying to inhale on top of already-full lungs, so you won’t get as much medicine in. Nearly 69% of patients were observed not exhaling fully away from the inhaler – a critical error. Take that moment to breathe out completely.
• Inhaling too fast or not deeply enough: A slow, deep inhale is key. If you inhale with a big sudden gasp, the medication can hit the back of your throat or cause the spacer to whistle (many spacers whistle as a built-in feedback mechanism). Fast inhalation was a mistake seen in almost half of patients in studies. Instead, breathe in slowly and steadily for a few seconds. If you hear a whistle, pause and restart inhaling more gently. Continue until your lungs are full to pull the medicine deep into the airways.
• Spraying multiple puffs at once: Only puff one spray at a time into the spacer, then inhale it. Do not press the inhaler multiple times in rapid succession into the chamber without inhaling. This can cause medicine to accumulate on the spacer walls or escape. It’s a common error to attempt two puffs together. Always do one puff -> inhale, then repeat if needed, waiting ~1 minute between puffs.
• Not holding your breath after inhaling: After you inhale the medication, don’t immediately blow it out. Holding your breath for about 5–10 seconds gives the drug time to deposit in your lungs. Many patients (around 40%) fail to hold their breath long enough. Try to count to ten (or at least to five) before exhaling. If you have difficulty, just do the best you can – even a few seconds help.
• Not waiting between puffs: If you need a second puff, wait about a minute before taking it. This pause allows the first dose to begin settling in your lungs and helps the second puff be more effective. Taking puffs too quickly back-to-back (or not re-shaking the inhaler between puffs) can reduce how much medication gets in.
• Skipping mouth rinsing (for steroid inhalers): If you’re using a steroid MDI (like for daily asthma control), always rinse and spit after your doses. Not rinsing can lead to thrush (a fungal infection in the mouth) or a hoarse voice over time. This is not an issue with rescue inhalers (like albuterol), but it’s a crucial step for any inhaled corticosteroid.
• Inconsistent cleaning of the spacer: A spacer can develop static or collect residue inside if not cleaned. Failing to clean the spacer regularly can cause medication to stick to the chamber walls instead of reaching you. We’ll discuss cleaning in the next section – but note that a grimy spacer can undermine your inhaler’s effectiveness.

Lastly, remember to occasionally check the inhaler’s dose counter so you don’t unknowingly use an empty inhaler, and replace the inhaler (or get a refill) before it runs out. Also, don’t float the canister in water to “test” if it’s empty – that old trick is not accurate. Use the counter or tracking of doses instead.

Caring for Your Spacer

Taking care of your spacer is important for hygiene and to maintain its performance. Here are some tips on spacer care and maintenance:

• Clean the spacer about once a week: For daily users, a weekly cleaning is generally recommended. If you use it less frequently, clean it every few weeks or as instructed by the manufacturer. Regular cleaning prevents buildup of medication residue and helps reduce static.
• How to clean your spacer: Remove the inhaler (and any detachable parts of the spacer). Wash the spacer in warm water with mild dish soap or detergent. You can let it soak for a few minutes. Gently shake the soapy water inside to loosen any film. Important: Do not rinse the spacer with plain water after washing. Leaving a slight film of dish soap inside actually helps dissipate static electricity on the walls of the spacer, so medicine won’t stick to the sides.
• Air-dry the spacer (don’t towel dry): After washing, let the spacer air dry completely (best done by propping it up on a dish rack or on a towel overnight). Do not wipe the inside dry with a cloth or paper towel; wiping can add static charge back to the chamber. By drip-drying, you preserve that anti-static coating from the detergent. Make sure it’s fully dry before next use. (Tip: Have a backup spacer on hand so you can use one while the other dries, especially if you need frequent doses.)
• Avoid damaging the spacer: Keep the spacer in a safe place when not in use. Don’t crush it in the bottom of a bag. If your spacer has a removable valve or other parts, be careful when reassembling after cleaning (follow the alignment instructions in its manual). If any part is cracked or broken, replace the spacer.
• Don’t share your spacer with others: Spacers are personal medical devices. To prevent infections or cross-contamination, each person should have their own spacer (just like a toothbrush). Mark yours with your name if needed to avoid mix-ups in a household.
• Replace the spacer as recommended: Over time, plastic spacers can develop micro-cracks or build up residue that’s hard to remove, and valves may become less effective. Generally, it’s a good idea to replace your spacer about every 12 months if you use it regularly. Replace sooner if it’s visibly damaged, if the valve doesn’t flap properly, or if instructed by your doctor. New spacers are relatively inexpensive and can ensure you’re getting the full dose of medicine.
• Store it properly: Keep your spacer in a clean, dry place. Avoid extreme temperatures. If it comes with a cap, use it to keep the mouthpiece clean. Some spacers are compact or have parts that fold – make sure any storage position doesn’t warp the plastic.

By caring for your spacer, you maintain its effectiveness and prolong its life. A clean, functioning spacer maximizes medication delivery to your lungs and minimizes waste.

Final Thoughts

Using an MDI with a spacer might feel a bit awkward at first, but with practice it becomes second nature. Many studies and clinical experts emphasize that correct inhaler technique can significantly improve your asthma or COPD control. Don’t be shy about reviewing these steps periodically or asking your healthcare provider to watch your technique. Small tweaks – like slowing your inhale or holding your breath a few seconds longer – can make a big difference in how much medication reaches your lungs.

Always follow the specific instructions for your inhaler medication (some may have slight variations). And remember, if you ever have trouble despite using the spacer (for example, if you just can’t coordinate or inhale deeply due to an illness), inform your doctor – there are alternatives like nebulizers or other inhaler types that might suit you better.

Your inhaler is a crucial tool in your lung health. Using it properly with a spacer ensures you get the relief or control the medication is meant to provide. With the step-by-step guide above, you’re well on your way to mastering your inhaler technique. Breathe easy, and take control of your health!

References:

• American Lung Association – How to Use a Metered-Dose Inhaler with a Spacer (Valved Holding Chamber)
• Mount Sinai Hospital – How to use an inhaler with spacer (Patient Instructions)
• Canadian Lung Association – How to Use a Puffer with a Spacer (Adult)
• National Asthma Council Australia – Using a metered dose inhaler with an AeroChamber spacer
• Columbia University Irving Medical Center – Health Library: Spacer for metered-dose inhaler
• Royal Children’s Hospital Melbourne – Asthma – use of spacers (Kids Health Info)
• Tara Haelle, CHEST Meeting Coverage – Common Inhaler Technique Errors in Adults (MDedge report, 2023)