Delivery Devices

Inhalers

Your healthcare provider will prescribe the inhaler that is best suited for your needs. You may need to try a few different devices to see what is best for you. There are a variety of different medications and devices for delivering them. Reliever and controller medications may use the same type of device for delivery. Asthma medication is inhaled directly to the airways to treat the airway inflammation and bronchoconstriction so it is very important that you use them correctly to ensure maximum benefit of the medication. Have your healthcare provider check that you have proper inhaler technique.

Several different kinds of asthma medicines are taken using an inhaler. Inhaled asthma medications go directly to the site of inflammation and constriction in the airways instead of traveling through the bloodstream to get there. Inhaled medications are the preferred therapy for asthma.

Many people do not use their inhalers properly, so the medication does not reach their airways. It is very important that you show your doctor, pharmacist, or asthma educator how you use your inhaler to make sure the medication is getting into your lungs, where you need it.

Inhalers fall into several categories:

Aerosol Inhalers/Metered Dose Inhalers (MDIs)

These are likely the one you are most familiar with: Also known as a “puffer”, this inhaler, or pressurized metered dose inhaler (pMDI), is a canister filled with asthma medication suspended in a propellant. When the canister is pushed down, a measured dose of the medication is pushed out as you breathe it in. Examples of MDI’s are: Ventolin, Flovent, Advair, Alvesco, Airomir, and QVar.

This medication should be used with a spacer for increased delivery to the airways. When your inhaler is used alone, medicine often ends up in your mouth, throat, stomach and lungs. Medicine left in your mouth, throat and stomach may cause unpleasant taste and side effects. When you use a drug delivery system (a spacer) with your inhaler, more medicine is delivered to your lungs.

Dry-powder inhalers:

Dry powdered inhalers contain a dry powder medication that is drawn into your lungs when you breathe in. Dry-powder inhalers most commonly refer to two devices.

• Turbuhalers: These devices deliver a dry powder medication as you breathe in. Loading this device is done by turning the dial at the bottom until you hear the ‘click’. Examples of a turbuhaler medication are Symbicort, Bricanyl, Pulmicort and Oxeze.
• Diskus: This powder medication is inhaled from a device that resembles a ‘hockey puck.’ Loading the dose is done by opening the device, sliding the loading lever and inhaling from the mouthpiece. Examples of Diskus medications are Advair, Ventolin, Flovent and Serevent. Review the use of your inhalers at your next visit with your Doctor, Asthma Educator or Pharmacist.

Some inhaler devices come with built-in counters that monitor the number of doses a person has taken and how many doses the device has left. If your inhaler doesn’t have a counter, ask your healthcare provider to show you how to monitor your dose.

Each inhaler requires a different technique for administration. One very important difference between the two types is that an aerosol puffer can be used with a spacer, while a spacer should not be used with a dry powder inhaler. Many inhalers need to be primed before first use or after a prolonged period of non-use. Prime your inhaler by releasing a number of test sprays (according to inhaler instructions) into the air, away from your face. Find instructions for specific inhalers in our Breathe Easy Medications Booklet.

Spacers

The most basic spacer is a tube that attaches to a puffer, so that you breathe the medication in from the tube instead of directly from the puffer. This makes it easier to “aim” the medication and breathe it right into the deepest part of your lungs, instead of having the spray end up in your mouth. If sprayed into your mouth, the medication can cause side effects like thrush (yeast infection). You can buy spacers from a pharmacy.

Also known as aerosol-holding chambers, add-on devices and spacing devices, spacers are long tubes that slow the delivery of medication from pressurized MDIs.

Spacers should always be used with MDIs that deliver inhaled corticosteroids. Spacers can make it easier for medication to reach the lungs, and also mean less medication gets deposited in the mouth and throat, where it can lead to irritation and mild infections.

While a spacer can make it easier to co-ordinate breathing in and activating an MDI, it can also make the MDI less portable because a spacer takes up extra space in a purse or a bag. However, inhaled corticosteroids are usually prescribed to be taken twice a day, so the spacer can be left at home for morning and evening use.

There are several other types of spacers available for people with specific needs. A large-volume spacer is useful for people who need to take their medication dose more slowly, over the space of five or six breaths. For young children, a spacer with a breathing mask attachment is often used. If you need to use one of these types of spacers, please ask your healthcare team how to use and maintain them.

Should I be using a spacer?

Asthma Canada recommends that anyone, of any age, who is using a puffer should consider using a spacer. A pharmacist, respiratory therapist, asthma educator, or doctor can assess how you use your puffer and will recommend the best device for you.

It is recommended that children use a spacer device with their puffer.

Spacers should not be used with dry powder inhalers — only with puffer-style devices. Puffers with either a rectangular or a round mouthpiece should be able to fit into a spacer — ask your healthcare provider for a demonstration if you are unsure how to set it up.

To use your puffer with a spacer:

1. Shake the inhaler well before use (3-4 shakes)
2. Remove the cap from your inhaler, and from your spacer, if it has one
3. Put the inhaler into the spacer
4. Breathe out, away from the spacer
5. Bring the spacer to your mouth, put the mouthpiece between your teeth and close your lips around it
6. Press the top of your inhaler once
7. Breathe in very slowly until you have taken a full breath. If you hear a whistle sound, you are breathing in too fast.
8. Hold your breath for about ten seconds, then breathe out.
9. If you need to take more than one puff at a time, wait a minimum of 30 seconds between puffs and be sure to shake the puffer (as in step 1) before each puff. Only put one puff of medication into the spacer at a time.

Cleaning Your Spacer

To clean your spacer, follow the instructions that come with it. In most cases, they will advise you to:

1. Take the spacer apart.
2. Gently move the parts back and forth in warm water using a mild soap. Never use high-pressure or boiling hot water, rubbing alcohol or disinfectant.
3. Rinse the parts well in clean water.
4. Do not dry inside of the spacer with a towel as it will cause static. Instead, let the parts air dry (for example, leave them out overnight).
5. Put the spacer back together.

If you are using your spacer every day, you should replace it about every 12 months.

Important Reminder about Spacers

Always follow the instructions that come with your spacer. As well:

• Only use your spacer with a pressurized inhaler, not with a dry-powder inhaler.
• Spray only one puff into a spacer at a time.
• Use your spacer as soon as you’ve sprayed a puff into it.
• Never let anyone else use your spacer.
• Keep your spacer away from heat sources.
• If your spacer has a valve that is damaged, or if any other part of the spacer is damaged, do not use it. The spacer will have to be replaced.
• Some spacers have a whistle. Your technique is fine if you do not hear the whistle. However, if you hear the whistle, this means you should slow your breath down.
• It is very important that you consult your healthcare professional to review proper inhaler technique.