A metered-dose inhaler (MDI) delivers medication as a rapid burst of aerosolized particles, requiring precise coordination between pressing the canister and inhaling simultaneously. An inhaler spacer is a plastic tube designed to attach to the MDI mouthpiece, creating a buffer zone for the medication. This device eliminates the need for perfect timing and helps ensure the medicine reaches the lower airways. Spacers are frequently used by children, the elderly, or anyone who finds the coordination of a standard inhaler challenging.
Purchasing Spacers: Over-the-Counter vs. Prescription Status
Many common spacer models are readily available for purchase over the counter (OTC) without a doctor’s prescription. You can typically find these devices at major pharmacies, medical supply stores, and online retailers. The OTC availability is generally because the spacer is classified as medical equipment rather than a regulated medication.
However, the acquisition process is not always straightforward, as some specialized or higher-end spacers may still be listed as prescription-only items. A prescription is often required if you intend for the device to be covered by a health insurance plan, allowing the cost to be processed through pharmacy benefits. Buying OTC can sometimes be less expensive than using a prescription with a high co-pay, but this varies depending on the specific model and your insurance coverage. It is helpful to inquire about both the cash price and the prescription cost when seeking a new device.
How Spacers Improve Medicine Delivery
Spacers significantly enhance the therapeutic delivery of inhaled medication by addressing the physics of aerosol dispersion. When the MDI is actuated, the medication is released at a high velocity, causing many particles to collide and deposit in the back of the throat or mouth. The chamber holds the dose in a suspension, effectively slowing the speed of these particles before they are inhaled.
This reduction in velocity allows the propellant to evaporate, which reduces the size of the remaining medication particles. The larger, ineffective particles stick to the walls of the spacer, allowing only the smaller, fine particles to remain suspended for inhalation. This mechanism, known as deep lung deposition, increases the amount of medicine that successfully reaches the lower airways. This improved delivery minimizes the amount of medication that settles in the mouth and throat, reducing the risk of local side effects like oral thrush, particularly when using inhaled corticosteroids.
Selecting the Right Device for Age and Need
Choosing the correct spacer depends heavily on the user’s age, coordination, and ability to form a tight seal. Spacers come equipped with either a mouthpiece or a face mask to accommodate different users. A mouthpiece is generally recommended for older children and adults who can create a firm seal with their lips around the device and coordinate a slow, deep breath immediately after the inhaler is pressed.
For infants, toddlers, and children typically under the age of five, a spacer with a tightly fitting face mask is necessary because they cannot reliably coordinate the “press and breathe” technique or hold their breath. The mask allows the child to breathe in and out normally (tidal breathing) over several breaths to receive the full dose. A poor seal with the mask can lead to drug loss around the face, making the fit a factor in effective delivery.
Key Features to Consider
Compatibility is a primary consideration, as not every MDI brand fits securely into every spacer brand; users must verify that the devices match. Some spacers also feature visual indicators or whistles that provide feedback, assisting in teaching proper inhalation technique to both adults and children. The volume of the chamber can also be a factor, with small-volume, non-valved spacers being less common than medium- to large-volume chambers that include a one-way valve.
Proper Cleaning and Replacement Schedule
Maintaining a spacer requires a specific cleaning method to ensure its continued effectiveness and prevent the buildup of static electricity. Most manufacturers recommend cleaning the device at least once a week by disassembling the parts and soaking them in lukewarm water mixed with a mild liquid dish detergent. Using detergent leaves a residue that helps to neutralize the static charge that can accumulate on the plastic walls.
After soaking, the parts should not be rinsed, as rinsing can remove the anti-static film and promote static buildup, causing medication particles to stick to the inside surface. The parts must be shaken gently to remove excess water and then allowed to air dry completely before reassembly. Spacers should generally be replaced every six to twelve months, or sooner if any cracks appear or if the one-way valve becomes stiff or damaged.