Spacer devices
A spacer device is a holding chamber that helps children with asthma to use their aerosol inhalers or metered dose inhalers (puffers) effectively. It is highly recommended that spacers be used by all children who require a puffer as this will allow more medication to be delivered directly to the airways. View video demonstrations at www.asthmainchildren.org.au
A small volume spacer with a mask - recommended for children aged under 4 years.
1. Remove cap and shake the puffer.
2. Fit the puffer into the end of the spacer.
3. Gently place the attached facemask over the mouth and nose of the child. Ensure there are no gaps around the edges of the mask.
4. Release one puff of medicine into the spacer by pressing down on the top of the puffer. Watch the child breathe normally in and out 4 to 6 times before removing the mask. If more than one puff (dose) is needed repeat step remembering to shake puffer before each dose.
A small or large volume spacer without a mask - recommended for children aged over 4 years.
1. Remove cap, shake the puffer well and insert into spacer.
2. Place mouthpiece of spacer between teeth, closing lips to form a seal. Push down on top of puffer to release 1 puff of medicine into spacer.
3. Take 4 normal breaths in and out through spacer. For each additional puff of medicine shake puffer and repeat steps 2 & 3. Masks can be attached to spacers for children under 4 years or those with developmental/cognitive delay.
Other asthma inhalation devices
A mask may be used with a spacer in hospital for older children during the night to avoid disturbing their sleep. In the daily home situation, children who are capable are encouraged to use the mouthpiece of the spacer.
View video demonstrations at www.asthmainchildren.org.au
As different medicines are available in different asthma inhalation devices it is important to follow the manufacturer’s instructions in regards to the priming requirements for each device, if any, and which devices have a dose counter etc.
Aerosols
A Metered Dose Inhaler (puffer)
It is recommended that a puffer is used with a spacer device, particularly in asthma first aid situations.
If a spacer device is unavailable, a puffer can be used on its own, however, as they require good coordination, children under seven years cannot successfully manage them. To use a puffer on its own:
- Remove inhaler cap/or mouthpiece cover.
- Shake the inhaler for 5 seconds.
- Breathe out gently, away from inhaler.
- Keeping the inhaler upright, tilt head back slightly.
- Place inhaler mouthpiece between teeth and close lips to get a good seal.
- Commence breathing in slowly and deeply, at same time pushing down on top of the inhaler to release 1 dose of medicine.
- Continue to breathe in slowly and deeply.
- Remove inhaler from the mouth and hold breath for 6 to 10 seconds.
- Breathe out gently, away from inhaler.
- If more medicine is required repeat steps 2 to 8.
- Replace inhaler cap/or mouthpiece cover.
Autohaler®
Not recommended for children under 7 years
- Remove mouthpiece cover.
- Shake autohaler®.
- Holding autohaler®. upright, push the lever on top into the upright position.
- Breathe out away from the autohaler®.
- Place the autohaler® in mouth, between teeth and close lips, ensuring a good seal.
- Breathe in slowly and deeply, continuing to breathe in after hearing the click.
- Remove autohaler® from mouth and hold breath for 6 to 10 seconds.
- Breathe out gently, away from inhaler.
- Push the lever back down.
- If more medication is required repeat steps 2 to 9.
- Replace mouthpiece cover.
Notes:
- Remember to push the lever upright to load the device.
- On commencement of breathing a clicking sound will be heard - continue to inhale after this for 6 to 10 seconds.
- Avoid placing thumb underneath device as this may cover the air vent and prevent it from working properly.
Dry powder devices
Turbuhaler®
Not recommended for children under 6 years
- Unscrew the turbuhaler® cover.
- With the turbuhaler® in the upright position, turn the coloured base to the right as far as it will go and then turn back to the left until it clicks.
- Breathe out away from the turbuhaler®.
- Place the turbuhaler® in mouth, between teeth and close lips to form a good seal.
- Breathe in fast and deeply.
- Remove the turbuhaler® from mouth.
- Breathe out.
- If more medication is required repeat steps 2 to 8.
- Replace the cap.
Notes:
- Turbuhalers® must be loaded in an upright position so you may find it easier to place it on a flat surface, holding the coloured base and turning the top section of the turbuhaler®.
- Avoid keeping device in humid or moist places.
Accuhaler®
Not recommended for children under 7 years
- Place thumb in groove and open accuhaler® by pushing the groove to the right until it clicks.
- Slide lever to the right until it clicks.
- Breathe out away from the accuhaler®.
- Place the accuhaler® in mouth, between teeth and close lips.
- Breathe in slowly and deeply.
- Remove the accuhaler® from mouth and hold breath for 6 to 10 seconds.
- Breathe out, away from the accuhaler®.
- Close accuhaler® by pushing thumb groove to the left.
- If more medication is required repeat steps 1 to 8.
Notes:
- Avoid keeping device in humid places.
- Accuhalers® should not be shaken.
Ellipta®
Currently this device only comes in Breo® which is not recommended for children under 12 years.
- When ready to take the dose, open cover by sliding it in a downward motion until you hear a click.
- Breathe out gently away for the Ellipta® device.
- Place mouth piece between teeth and close lips to create a good seal.
- Breathe in steadily and deeply for up to 5 seconds.
- Remove Ellipta® device from mouth and breathe out gently away from it.
- Slide the cover upwards as far as it will go to cover the mouthpiece.
- If more doses are required repeat steps 1- 6.
Notes:
- The Ellipta® Device should not be shaken.
- Only open the cover when ready to take a dose as each time the cover is opened the dose counter counts down one dose.
- Avoid covering the vent on the device with your hand.
Cleaning spacer devices, puffers and other medicine inhalation devices
Spacers
- Take the spacer apart if possible.
- Wash in warm soapy water (dishwashing liquid).
- Do not rinse.
- Allow the parts to air dry. Rinsing and drying with a cloth may cause static electricity to build up resulting in the medication clinging to the inside of spacer.
- When dry put spacer back together ready for use.
Note:
Some spacers are made from anti-static material therefore these spacers can be rinsed and dried with a cloth without creating static electricity.
Puffers
- Remove the canister from the plastic holder.
- Do not wash the canister.
- Rinse the plastic holder under warm running water.
- Shake out excess water and dry.
- Place the canister back in the holder.
- Keep the cap in place when not using puffer.
Clean your spacer and puffer canister regularly and whenever the puffer does not spray well.
Change and wash Intal ® and Intal® Forte plastic holders daily to prevent blockage (an extra holder is supplied).
There is no need to wash other medicine plastic holders - just wipe the mouthpiece with a cloth.
Store puffer below 20 degrees Celsius and regularly check the expiry date, found on the side of the canister.
Other asthma medicine inhalation devices
Turbuhalers®, accuhalers®, autohalers®, and elliptas® only require minimal cleaning which consists of wiping the mouthpiece with a tissue after use and replacing the cover of the turbuhaler® and autohaler®, or closing the accuhaler® and ellipta®.
As turbuhalers ®, accuhalers®, and elliptas® contain dry powdered asthma medicine, it is important that they do not come into contact with moisture. Therefore, do not breathe directly into these devices or wash under tap water.
Remember:
- Have your child’s asthma device technique checked regularly by a health professional
- When devices are used correctly, more medicine gets to the lungs
- Poor device technique can result in poor asthma control
For more information on children and Asthma, download the "Asthma and your child: Resource pack"
