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Children’s spacers for the treatment of asthma: top ten tips

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A spacer should always be used when a young child A spacer should always be used when a young child is prescribed a pressurised metered dose inhaler (pMDI)

Tip 1: Always prescribe a spacer with a metered dose inhaler

The purpose of the spacer device is to act as an intermediary chamber into which a pressurised metered dose inhaler (pMDI) can discharge the drug. This slows down the drug, which is propelled at force as an aerosol, allowing evaporation. This increases the respirable particle fraction leading to better lung deposition.1 For this reason, a pMDI should always be used with a spacer device in young children and is recommended in adults who may have poor manual dexterity and/or learning difficulties.2

Using a metered dose inhaler without a spacer is difficult. All the metered dose inhaler systems (MDI) require co-ordination of activation and inhalation and may be difficult to use, particularly for younger children. In addition, inhaler technique in health care professionals, who may be teaching technique to parents and children, is poor too. In a questionnaire of health care professionals in Ghana only 9 out of the 75 (12%) participants all of whom were doctors knew at least three essential steps of the techniques in using a pMDI correctly. None of the participants got all the steps totally correct.3

Tip 2: Choose a spacer with a valve

There are two types of devices:

Spacers – which are an additional reservoir between the mouthpiece of the pMDI and the patient’s mouth


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