What are Inhalation Spacers and Why are They Needed?
The most common method of treating bronchial asthma is individual metered-dose inhalers. But their use is associated with a number of disadvantages, and, often, it is completely ineffective. This problem is successfully solved when using spacers.
Inhalation therapy is an effective method of treating allergic dis-eases of the respiratory tract, including asthma. As a rule, it is carried out by various types of aerosol inhalers, nebulizer devices, which convert liquid drugs into aerosols by spraying with compressed air or ultrasound. Aerosol inhalers are well known to many patients, however, there are some fundamental aspects of using aerosol inhalers that affect the effectiveness of inhalation.
Until recently, a patient using an aerosol inhaler inhaled directly from the mouthpiece of an aerosol can. Experience has shown that due to the high speed of aerosol particles escaping from the nozzle of the can, a fairly large part of the drug does not reach the bronchi and, accordingly, does not have a therapeutic effect. At the same time, settling in the oral cavity and pharynx, the drug has a side effect on the body. In addition, the use of inhaled hormones directly from the mouthpiece increases the likelihood of fungal diseases of the oral cavity.
These disadvantages can be avoided by using special nozzles for aerosol inhalers, which are called spacers!
What are spacers?
Spacers are plastic flask-shaped products that have a hole at one end into which the mouthpiece of an aerosol inhaler is inserted and at the other end a mouthpiece through which the patient inhales the sprayed drug. When inhaling the drug, large particles that would settle in the oral cavity settle on the walls of the spacer, while small particles that make up the useful aerosol fraction hang in the air space of the spacer (spacers are made of special antistatic plastic that repels small ones – valuable for the patient – aerosol particles), forming a uniform aerosol. As a rule, spacers are disassembled into parts, as they must be washed after use.
Adults and children under 5 years old need different types of spacers, this is due to the anatomical and physiological differences between the adult and children’s organisms. Children under 5 years of age cannot effectively use the mouthpiece, they are also unable to perform a specific breathing maneuver, so they need a special spacer with a mask and valves.
When is a spacer especially needed?
- Patients who are using aerosol inhalers for the first time;
- Patients of any age with poor inhalation technique;
- Patients receiving high doses of drugs;
- Patients receiving inhaled hormonal drugs;
- Patients with nocturnal asthma;
- Patients prone to rapid and severe attacks of suffocation.
Who does a spacer work?
The most effective medicines for bronchial asthma and chronic obstructive bronchitis are administered by inhalation. They are specially designed to be as effective as possible locally (topical), and as little as possible to affect the entire body (minimal systemic effect). Therefore, it is of paramount importance to ensure the direct entry of the medicinal substance to the place of its action, i.e. into the bronchi.
For this, the following conditions are required: first, only particles of a certain size (2-5 microns, the so-called respirable fraction) enter the lower respiratory tract. The larger ones are deposited in the pharynx, larynx and trachea, and the smaller ones – in the alveoli, or do not stay in the lungs at all. Secondly, the patient must take a sufficiently strong and deep breath. Thirdly, the release of the medicine and the inhalation must match.
The most popular and affordable inhalation drugs are metered-dose aerosol inhalers. But their application is fraught with some difficulties. The aerosol jet generated by pressing the can has a high initial velocity – more than 100 km / h, the inhalation rate is much lower – and consists of a mixture of particles of a larger and smaller size. This leads to the fact that most of the drug settles on the back of the pharynx and is swallowed. Coordination of inhalation and pressing the balloon are required, which is difficult, and in some patients, the inhalation is reflexively interrupted. According to various studies, only 20-40% of patients use a metered-dose inhaler correctly (even experienced).
The task of the spacer is to eliminate difficulties and problems. It slows down the speed of movement of the aerosol cloud, large particles settle on the walls. Coordination of inspiration and pressure is not required. In addition, the spacer with a mask allows inhalation in almost any situation where spontaneous breathing persists, for example, in a severe asthma attack. With the help of the spacer, inhalation becomes possible in children who are too small to use inhalers directly. The spacer can be taken with you (not everyone can afford to have a portable rechargeable nebulizer model).
Benefits of using an inhaler spacer for asthma
- Uniform spray. The inhalation spacer filters out large aerosol particles and slows down the rate of drug intake into the body, does not interrupt reflex inhalation. The atomization rate of simple metered-dose inhalers exceeds the inhalation rate, so the medicine settles on the back wall of the nasopharynx and trachea and does not enter the lower parts of the bronchi;
- No movement coordination required. The spacer for children with respiratory diseases is a simple way to quickly, gently and effectively relieve an attack because the child does not have to try to synchronize inhalation and pressing the bottom of the inhaler;
- The presence of a mask. The use of a spacer with a mask is necessary for children and the elderly, as it helps to avoid the deposition of particles of medicines on the face and makes it possible to carry out the inhalation procedure in any conditions;
- Small size. The length of the spacer chamber does not even reach 12cm, so it is convenient to take it with you especially if you are prone to asthma attacks.
How to use a spacer: a step-by-step guide
- To be effective, the spacer must be used correctly;
- Before inserting the inhaler into the spacer, remove the protective cap from the inhaler (and from the spacer, if available; at-tach a mask, if necessary);
- The can of the inhaler should be turned upside down and the mouthpiece down (not in reverse!);
- It is recommended to shake the aerosol can in most cases after it has been connected to the spacer (together with the spacer);
- Before inhalation, take a deep breath;
- Lips should tightly cover the mouthpiece of the inhaler, teeth should not be clenched so as not to obstruct the entry of aerosol;
- Inhalation from the spacer should be carried out as soon as possible after spraying the aerosol (after 1-2, up to 5 seconds). The inhalation should be full, deep and not too fast. In a number of spacers, it is recommended to take several breaths per dose;
- After inhalation, you should hold your breath for 5-10 seconds, then make a calm exhalation;
- If multiple doses are to be inhaled, they should be inhaled sequentially with an interval of about 30 seconds, not simultaneously;
- After inhalation of hormonal drugs, you should rinse your mouth (and if you use a mask, you should also wash your face);
- The spacer should be washed in time and replaced with a new one if damaged or after the time specified in the instructions;
- Pay attention to cleaning instructions: most spacers are non-boiling and non-corrosive and are often not recommended to be wiped off with a cloth. Special care must be taken with valves.
How to choose a spacer?
The connecting hole of the spacer (the place for attaching a can with a dosed aerosol) must correspond to the size and shape of the mouthpiece of the can or be universal. A number of spacers are compatible only with aerosol inhalers of certain companies. The spacer must be of sufficient size or have an aerodynamically correct shape. In children, it is recommended to use spacers equipped with valves, while in small children, it is desirable to have both inhalation and exhalation valves. Some spacers are universal, and some are designed for a certain age (for example, for children under 5 years old). The spacer must be made of hypoallergenic materials. The anti-static coating improves the performance of the spacer. If the spacer is disassembled, then it is easier to care for it. Children of the first years of life need a spacer with a mask. Older children, elderly, weakened patients, those who have severe attacks should purchase a spacer with a removable mask because they can switch to using the spacer without a mask.
Frequently asked questions about spacers
What are the minimum dimensions for a spacer?
The minimum length is 5 cm, but larger spacers are more efficient.
Is a high volume spacer always needed?
To be effective, the spacer must have a large volume, but then it is inconvenient to carry. Most of the large volume spacers are foldable, but still take up a lot of space. Therefore, there are spacers with a shape that is aerodynamically verified so that the speed of the aerosol jet and the particle size are ideal. Such spacers no longer need huge sizes.
Do you need a mask?
If you are able to use the spacer without a mask, then you’d better do it since the use of a mask reduces the effectiveness of the treatment: part of the medication is deposited on the face. The mask is a necessity in children under 5 years of age, who are not yet able to use it; they are usually used in children under 5 years of age, it may be needed for weak and elderly patients, as well as patients in serious condition. Some patients require a mask psychologically.
What is the role of the valves in the spacer? Are they always needed?
The most advanced spacer models have valves. This prevents aerosol loss and facilitates handling by allowing multiple breaths from the spacer. For children, it is recommended to use only valve spacers.
Why is the use of a spacer especially important when treating with inhaled hormonal drugs?
In the case of hormonal inhalation drugs, the ingestion of a significant part of the dose on the back of the pharynx and in the upper respiratory tract can lead to hoarseness of the voice and candidiasis (“thrush”) of the oral cavity, cause a reflex cough. In addition, in the future, that part of the drug that settles in the pharynx is swallowed and can cause a systemic effect. The spacer reduces the sedimentation of drugs in the pharynx and upper respiratory tract, thereby preventing such complications. All patients who are prescribed inhaled hormonal drugs in the form of a metered aerosol are recommended to use them through a spacer.
How to use a spacer? Should the rule “one dose, one breath” always be followed?
The best option is to inhale one dose with one spray. If 2 doses are needed, give 2 separate inhalations at short intervals (usually about 30 seconds). Inhalation of several doses from a spacer is less effective than using the same doses separately (this technique is sometimes used for severe attacks). On the other hand, very young children are not able to inhale the entire volume from the spacer in one breath. Spacers for them usually have inhalation and exhalation valves. In addition, the patient is not always able to take a deep enough breath, and during the time that the aerosol in the spacer remains unchanged (about 30 seconds), it is possible to take not one but several breaths.