Do your patients use a spacer with their puffer?
Using a spacer with a puffer makes it easier for people to take their medication, reduces the risk of local adverse effects and also increases drug delivery to the airways. Generally, using a spacer with a puffer is much better than using a puffer alone. Asthma Australia and the National Asthma Council recommend that everyone use a spacer with their preventer puffer and many people can benefit from using the spacer with their reliever medication also.
Who should be using a spacer?
All children should use a spacer to take their medication, for both reliever and preventer puffers.
Adults and adolescents are recommended to always use a spacer with their preventer puffer, when symptoms are not relieved when using their reliever inhaler on its own, and whenever possible for acute asthma.
There are two techniques when using a spacer with a puffer.
The single breath technique is the preferred option as the delivery of the medicine to the airways is maximised when the patient takes a slow, deep breath from the spacer after each actuation. This technique may not be possible for very young children or when someone is experiencing acute asthma.
Tidal breathing through the spacer (e.g. four breaths in and out without removing the spacer) is used in acute asthma and for very young children. First aid instructions should include how to use inhaler and spacer.
Multiple actuations of a puffer into a spacer can reduce the amount of respirable medicine available because the particles join into larger particles or become attached to the spacer walls.
Shake the puffer before every puff (whether using a spacer or not). If using a spacer, either disconnect the puffer and shake it before reconnecting to spacer, or take the spacer mouthpiece out of the mouth and shake the puffer while still connected to the spacer.
Are your patients user their asthma devices and spacer correctly?
We know that up to 90% of people use their asthma medication devices incorrectly. To help people use their devices correctly health professionals should train patients to use their inhaler devices.
Check the person’s inhaler technique at each encounter:
Have the patient demonstrate their inhaler technique, while checking against a checklist of steps for the specific device – don’t just ask if they think they know how to use it properly.
Demonstrate correct technique using a placebo device and correct any specific errors identified.
Have the patient repeat the demonstration to check they can now use the device correctly. If necessary, repeat instruction until the patient has all steps correct.
For people instructed to use a spacer with their inhaler, ask in a non-judgemental manner whether they sometimes or often use the inhaler alone. Emphasise that using the spacer is an important part of correct technique for best results.
Checklists of steps, and videos demonstrating correct technique are available from NPS Medicinewise and Asthma Australia
Ask patients to bring their spacer with them to be checked every 6–12 months. Check that there are no cracks and that the valve is working.
Advise all patients using inhaled corticosteroids to rinse their mouth with water and spit after each dose, if possible.
What about in the clinic?
In clinical settings, when delivering salbutamol by pressurised metered-dose inhaler for patients with acute asthma:
Where can patients get a spacer?
Patients can buy a spacer from their local pharmacy, usually from around $15. Spacers can also be purchased from Asthma Australia through the online store or by contacting the 1800 ASTHMA Helpline (1800 278 462) and have it mailed to them.
Asthma Australia are also the exclusive stockist of the brand new Able Spacer 2 – the winner of the 2018 First Aid Product of the Year.
Download (PDF 2.1MB) the Abe Spacer 2 information sheet and visit our shop to purchase.
If your patients have more questions about their asthma, devices and self-management, refer them to Asthma Australia to speak with an educator – 1800 ASTHMA Helpline (1800 278 462) .
Reference NAC Handbook http://www.asthmahandbook.org.au/management/devices