Combivent and DuoNeb inhalers contain both albuterol and ipratropium (a bronchodilator); albuterol and ipratropium may also be given using a nebulizer . If there is a spacer device such as a mask, place it over your child's nose and mouth, making sure there is a good seal. If there is just a mouthpiece, the tip should go between the teeth, with lips wrapped tightly around to make a good seal. Hold your breath for the length of time specified for the medicine you are taking to allow the medication to reach your lungs. McIvor RA et al. Optimizing the delivery of inhaled medication for respiratory patients: the role of valved holding chambers. Canadian Respiratory Journal 2018. Formerly called metered dose inhalers (MDIs), HFAs give the drug through a small, handheld aerosol canister. They work like a spray can. You push the inhaler, it sprays out the medicine, and you breathe it in. A tube-like gadget called a spacer can help kids or people with trouble breathing use an HFA more easily.

Designed to deliver more medication to the lungs than pMDI alone 1, enabling patients with asthma and COPD to take control. If you’re using a spacer with rubber valves, replace it if the valves become stiff or brittle. Tips for cleaning your spacer If you notice your spacer making a whistling sound, that means you’re breathing in too fast. If you need to take another dose, take the mouthpiece or mask away from your face, wait 30 seconds to a minute and shake the inhaler again. Then repeat the steps. If your child or an adult uses an HFA every day to control asthma symptoms, you can figure out how long it will last by dividing the total number of puffs in the HFA by the total puffs used every day. For example, if the HFA has 200 puffs and they use four puffs per day, divide 200 by four. In this case, the HFA would last 50 days. Using a calendar, count forward that many days to learn when to discard the HFA and begin using a new one. Long-acting beta-agonists ( Foradil , Serevent ). The combination inhalers containing both a long-acting beta-agonist and a steroid include Advair , Dulera, and Symbicort .A valved holding chamber is a type of spacer that includes a one-way valve at the mouthpiece. This device does more than provide "space" between your mouth and the medicine. It also traps and holds your medicine, which gives you time to take a slow, deep breath. This allows you to breathe in all of the medicine. Hold the inhaler with your index finger on top of the canister and thumb on the bottom of the plastic mouthpiece. Anti-static Space Chamber Plus* traps and holds medication in suspension for longer so patients have more time to breathe in. Open your mouth wide, and place the inhaler about 2 inches in front of your mouth. (Or you can put the HFA in your mouth, between your teeth, with your tongue flat under the mouthpiece and your lips sealed.)

When the treatment is complete, remove the HFA from the space chamber. Replace the caps on the asthma inhaler and spacer.Suggett J et al. The impact of inhalation delay on lung drug delivery: using functional respiratory imaging (FRI) to compare metered dose inhaler (MDI) and MDI/Valved Holding Chamber (VHC) Systems. Am J Respir Crit Care Med 2020;201:A5889. A spacer is a plastic tube that fits onto the mouthpiece of your inhaler. It helps you breathe the medicines into your lungs more easily. Spacers are used with pressurised metered dose inhalers or pMDIs. Keeping your spacer clean and in good condition helps make sure it works properly and you get the best from your medicines. When you first get a new spacer, clean it before you use it. After that you should usually clean your spacer once a month. Testing of a prototype: Suggett et al. Impact of inhalation delay on medication delivery from a salbutamol HFA pressurized metered dose inhaler used with and without a new prototype portable valved holding chamber. European Respiratory Journal 2019 54:PA4229. Compact version easily fits into school bags, handbags or briefcases to allow easier storage and handling There are two breathing techniques for adults and children to use with a spacer: ‘tidal or multiple breathing’ and ‘single breath and hold’:

Don’t put your spacer in a plastic bag as this will cause it to build up static and reduce the effect of the asthma medicine. Levy ML et al. Asthma patients’ inability to use a pressurized metered-dose inhaler (pMDI) correctly correlates with poor asthma control as defined by the Global Initiative for Asthma (GINA) strategy: a retrospective analysis. Prim Care Respir J. 2013; Dec;22(4):406-11 Take your spacer apart and gently clean it with warm water and a detergent, such as washing-up liquid.

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Cross Valve Technology™ ensures very low resistance during inhalation and also allows easy exhalation through the chamber Take a slow, deep breath, holding for 5-10 seconds, or slowly and steadily inhale and exhale 4-5 times.