Using a spacer correctly: inhaler tips for children with asthma
A spacer makes using a metered-dose inhaler much easier for children. Still, small mistakes creep into everyday routines – and then less medicine reaches the lungs. This guide summarises what matters.
Why technique matters
In a large review of more than 54,000 patients, only 31% used their inhaler completely correctly1. With metered-dose inhalers, the most frequent errors were no breath-hold, poor coordination of actuation and breath, and breathing in too fast or not deeply enough1. Actuating before breathing in is associated with poorer asthma control2.
A spacer removes the hard part of coordinating actuation and breath. But it still takes practice: in one study, only 8% of parents of young children used a newly prescribed spacer correctly with the standard picture instructions3.
- No breath-hold after inhaling 46% 46% of patients · Sanchis et al. 20161
- Actuation and breath not coordinated 45% 45% of patients · Sanchis et al. 20161
- Breathing in too fast or not deeply enough 44% 44% of patients · Sanchis et al. 20161
- Actuation before breathing in (critical error) 24.9% 24.9% of patients · Price et al. 20172
Share of patients making each error; multiple errors possible, values do not add up.
Step by step: metered-dose inhaler with a spacer
This is how patient organisations and children's hospitals describe tidal breathing with a mask or mouthpiece6,7,8. Always follow the instructions of your care team and the leaflet of your spacer.
- PrepareTake off the cap, check there is nothing inside the mouthpiece, and shake the inhaler well.
- ConnectPut the inhaler into the opening at the end of the spacer.
- PostureYour child sits or stands up straight with the chin slightly tilted up.
- SealPlace the mask over nose and mouth to make a seal – or your child closes the lips tightly around the mouthpiece.
- One puffPress the inhaler once. Only ever put one puff into the spacer at a time.
- Breathe calmlyYour child breathes in and out slowly and steadily into the spacer about five times.
- Next puffIf another puff is prescribed: wait 30 to 60 seconds, shake again and repeat the steps.
- AfterwardsAfter steroid inhalers, rinse the mouth or brush teeth; with a mask, wipe the face with a damp cloth.
Older children may – if agreed with the care team – take one slow deep breath and then hold it for up to 10 seconds7.
Common pitfalls in everyday life
Several puffs at once
Only put one puff at a time into the spacer and repeat the steps for every puff6,8.
No pause between puffs
In one study, not waiting between two puffs was the most common error when parents used a spacer4.
Mask or lips not sealed
The medicine only reaches the airways from the spacer if there is a tight seal6,7.
Spacer rubbed dry
Rubbing creates static – the medicine then sticks to the inside wall instead of reaching the lungs8.
Explained once, never checked
Children inhale correctly far more often when their technique is checked repeatedly instead of being explained only once5.
Cleaning and replacing the spacer
Take the spacer apart, soak it in warm water with a little washing-up liquid, do not rub it, and let it air-dry completely. How often to clean is stated in your spacer's leaflet; a spacer should be replaced about every 6 to 12 months8.
Video instructions
Asthma + Lung UK offers free videos on using a spacer with and without a mask6,7; the German Respiratory League (Deutsche Atemwegsliga) offers videos in several languages9.
Have the technique checked regularly
Ask your child to demonstrate their inhaler technique at medical appointments or at the pharmacy so it can be corrected – especially after a device change5.
Where SereneAir comes in
These are exactly the moments that stay invisible in everyday life. SereneAir is being developed as a smart spacer designed to show whether dose, timing, flow and technique were right – and to give families clear feedback. SereneAir is in development and not yet available.
Updates & waitlistThis guide is for general information and does not replace medical advice or instruction. Please always discuss your child's therapy with your care team.
Sources
- Sanchis J, Gich I, Pedersen S; ADMIT. Systematic review of errors in inhaler use: has patient technique improved over time? Chest. 2016;150(2):394-406. doi.org/10.1016/j.chest.2016.03.041
- Price DB, Román-Rodríguez M, McQueen RB, et al. Inhaler errors in the CRITIKAL study: type, frequency, and association with asthma outcomes. J Allergy Clin Immunol Pract. 2017;5(4):1071-1081.e9. doi.org/10.1016/j.jaip.2017.01.004
- Topal E, Arga M, Özmen H, et al. Effects of modifying visual inhaler spacer usage instructions on correct usage rate of untrained users. Int Forum Allergy Rhinol. 2020;10(1):69-74. doi.org/10.1002/alr.22440
- Deerojanawong J, Promsaka na Sakolnakorn V, Prapphal N, Hanrutakorn C, Sritippayawan S. Evaluation of metered-dose inhaler administration technique among asthmatic children and their caregivers in Thailand. Asian Pac J Allergy Immunol. 2009;27(2-3):87-93. pubmed.ncbi.nlm.nih.gov/19839493/
- Kamps AW, van Ewijk B, Roorda RJ, Brand PL. Poor inhalation technique, even after inhalation instructions, in children with asthma. Pediatr Pulmonol. 2000;29(1):39-42. pubmed.ncbi.nlm.nih.gov/10613785/
- Asthma + Lung UK. How to use a spacer with a mask for a baby or child. www.asthmaandlung.org.uk/living-with/inhaler-videos/spacer-with-mask
- Asthma + Lung UK. How to use a spacer without a face mask for a child. www.asthmaandlung.org.uk/living-with/inhaler-videos/spacer-no-mask
- Royal Berkshire NHS Foundation Trust. Spacer devices for children (patient information, October 2024). www.royalberkshire.nhs.uk/media/wh4pu3jh/spacer-devices-for-children_oct24.pdf
- Deutsche Atemwegsliga e.V. Richtig inhalieren – Videos. www.atemwegsliga.de/richtig-inhalieren/zu-den-videos.html