Spacer devices

Spacers improve drug delivery to the lungs by allowing the aerosol to decelerate and the propellant to evaporate. They are particularly useful in

• children
• people on high doses of corticosteroids
• people with poor inhalation techniques (difficulties with coordinating actuation of an inhaler and inspiration) (1).

Spacers maximise the amount of medication delivered to the lung by allowing the aerosol to decelerate and the propellant to evaporate. This minimises the amount of drug deposited in the mouth and throat, thus reducing the incidence of oral candidiasis and dysphonia.

• the aerosol should be inhaled immediately after actuation; the device should not be actuated multiple times in quick succession (2)
• they are not interchangeable, and people should always use the type of spacer that is compatible with the inhaler (1)
• they should be replaced at least every 12 months (some spacers after 6 months) (2)
• careful washing and air-drying of plastic spacers at appropriate intervals is needed to reduce adhesion of the drug to the surface (which reduces its delivery) (3)

References:

1. MHRA. Inhaled products that contain corticosteroids. Drug Safety Update;2008:1(12),6-7.
2. Scottish Intercollegiate Guidelines Network (SIGN) and British Thoracic Society (BTS) 2009. British guideline on the management of asthma: a national clinical guideline (revised 2009).
3. National Institute for Health and Clinical Excellence (NICE) 2002. Inhaler devices for routine treatment of chronic asthma in older children (aged 5 - 15 years).