A spacer is a simple device that's proven to make an inhaler work better.  In fact, studies show they make an inhaler work 75 percent better, reduce side effects, and improve coordination.  Yet most asthmatics -- perhaps as many as 90 percent -- don't use one.

Albuterol inhaler with AeroChamber spacer

Most asthma rescue inhalers are metered dose inhalers.  This means that every time you squirt the inhaler you get the same amount of medicine squirted into your airway.  Yet one flaw with this design is the medicine is prayed so hard and fast into your mouth most of the medicine crashes into your upper airway instead of getting to your air passages.

A good way to test this theory for yourself is to take your inhaler, stick the mouthpiece into your mouth, and squirt it.  You'll notice that the spray hits you in the back of your mouth, producing a bitter taste.  Any medicine you can taste in your mouth is medicine that doesn't get to your lungs.  It's also medicine you swallow, and this causes systemic side effects.

Another problem many people have with inhalers is coordination.  Some asthmatics inhale too early.  some asthmatics inhale too late.  Most asthmatics inhale too fast, and this results in turbulence that causes the medicine to impact into your airway.  All of these coordination issues results in the medicine being less effective.

The spacer was meant to solve all these problems.  The concept was first thought up in the 1980s after various studies were done on the topic.  When I was a kid I was advised to use a toilet paper roll as a spacer.  This was a crude design, yet it worked.  

The idea is that the larger particles of the medicine will impact on the sides of the chamber instead of in your mouth.  The spacer also helps slow down the force of the spray so the medicine doesn't impact in your upper airway as much.  It also makes the inhaler easier to use, and improves coordination.

Ultimately pharmaceutical companies decided they could profit by the need for spacers, and now you can find many different designs of spacers.  My favorite is the AeroChamber.  A neat thing about it's design is if you inhale too fast the device will whistle.  In this way it teaches you inhale slow and smooth.

Another neat thing about the AeroChamber is you can squirt the medicine before you put the spacer into your mouth.  This works nice especially for the elderly and little kids who have trouble with coordination.

Using a spacer is pretty simple.  First you shake the inhaler, and then you insert the mouthpiece of the inhaler on the back end of the spacer.  Then you put your mouth on the mouthpiece of the spacer.  .  Just as you begin inhaling you squirt the inhaler.  You should then take in a full, deep and slow breath, and hold your breath for 5-10 seconds.

I like to advise my patients to not take their mouth off the mouthpiece until they are finished holding their breath.  After taking a first puff you wait 3-5 minutes before taking a second puff.  The first puff opens up your air passages and the second puff does the mop up job.