How to use a pMDI inhaler with a spacer – tidal breathing

Hello, I’m Pam. I’m a respiratory nurse specialist. Using a spacer with your inhaler means more of the medicine gets down into your lungs and is a great way to help manage your symptoms. Getting the technique right is very important. It may take a few tries to feel comfortable using a spacer, but it does get easier with practice. I’m going to show you how to use an inhaler with a spacer using what’s called ‘tidal breathing’ or the ‘multiple breath’ technique. This is usually recommended if you can’t hold your breath for five seconds after using your inhaler or if you are having an asthma attack. For most adults and older children, your spacer can be used with a mouthpiece, but a spacer with a mask may be given to you if you cannot put your lips around the mouthpiece to form a tight seal. If your doctor or nurse has recommended a different technique called the ‘single breath and hold’, watch our other video. And if you’re helping a baby or child use a spacer, watch our videos on children and spacers. To use your inhaler with a spacer using the tidal breathing technique: First, hold your inhaler upright and take the cap off. Check there’s nothing inside the mouthpiece. Shake it well. If your spacer has a valve, make sure the valve is facing upwards. Put your inhaler into the hole at the back of the spacer. If the mouthpiece of your spacer has a cap, take it off. Sit or stand up straight and slightly tilt your chin up as it helps the medicine reach your lungs. The next steps all happen smoothly in one action. Put your lips around the mouthpiece of the spacer to make a tight seal. Press the canister on the inhaler once to release the medicine and breathe in and out slowly and steadily into the spacer five times. Remove the inhaler and spacer from your mouth. If you’ve been prescribed a second puff, keep the spacer away from your mouth, wait a minute and shake the inhaler again. Then repeat the steps. Some small volume spacers make a whistling sound if you are breathing in too fast. If you are using a large volume spacer like this one, you can use the same breathing technique. With tidal breathing your spacer should make a clicking sound as the valve opens and closes. When you’ve finished, take the inhaler out of the spacer and replace the caps on both the inhaler and the spacer. If you’ve used an inhaler that contains steroids, rinse your mouth with water and spit it out to reduce the chance of side effects. For top tips on how to clean your spacer, please visit our website.