Metered Dose Inhaler with Spacer or Valved Holding Chamber


Metered dose inhalers (MDIs) are useful in treating asthma and other respiratory problems.

 An MDI has two parts:

  • A canister.
  • Curved mouth piece.

These small hand-held devices propel or send needed medicine directly to the lungs by combining medicine and a propellent (such as HFA or hydrofluoroalkane). But, the medicine only works if the MDI is used in the proper way. It is important to inhale while you press down on the MDI canister  (Refer to the insert provided by the manufacturer of the medication in the packaging). Most MDIs (except for MAXAIR (pirbuterol), QVAR, or Combivent Respimat, and all dry powedered inhalers) can be used with valved holding chamber or spacer. Adding a  valved holding chamber or spacer device to an MDI provides many benefits to the patient no matter their age or ability. WVAEPP recommends that all individuals regardless of age should have a spacer or valved holding chamber when using an inhaler.

Spacer and Valved Holding Chamber Description

A spacer is a 4 to 8 inch long tube that fits on the end of the MDI mouthpiece. Use of an MDI may be only one part your treatment. Holding Chambers/spacers are by prescription only, and can be found at some pharmacies or durable medical equipment companies. Contact your physician to get one today.


  • Helps you to breathe at your own pace.
  • Allows more medicine to reach your lungs.
  • Prevents medicine from escaping into the air.
  • To be used with all age groups (spacers with masks for young children are also available).

The name spacer is used interchangeably for all devices that aid in inhaling medication, however a Valved Holding Chamber has a one-way valve inside that prevents the medicine from escaping once you have pressed down on the MDI canister. Both types, either spacer or valved holding chamber, are used with an MDI to increase the amount of medicine reaching deeper into the lungs. Some MDIs cannot be used with a spacer, ask your physician or pharmacist about your medications.

Dose & Administration

In what order should I take my inhaled medications?

Take only the number of doses (puffs) prescribed. Do not use someone else medications.

If you are taking more than one inhaler, it is important to take them in the correct order. The order can make a big difference! Be sure to discuss this with your doctor, pharmacist, certified asthma educator, respiratory therapist, or nurse.

If your asthma is under control you should only be using your “controller” medication – either a metered dosed inhaler, or a dry powdered inhaler as prescribed. Some individuals also take a pill to control their symptoms such as a leukotriene modifier (Singulair).

For individuals who have more severe disease or are suffering asthma symptoms, typically, FIRST you should use your “Quick Relief” rescue medication known also as a bronchodilator. Some of these products are known by their generic or name brand such as Albuterol (ventolin, proventil, proair), Levalbuterol (xopenex), or Pirbuterol (Maxair) which will open up the lungs and allow you to breathe easier when inhaled properly.

After using the Quick Relief medication, wait about 10 minutes or more and then use your long-acting inhaled “controller” medication. These are called corticosteroids which include brand names such as ( pulmicort, flovent, asmanex, QVAR, etc.), or you may be prescribed a combination medication – these medications have a corticosteroid and a long-acting bronchodilator. Current combination medications include name brands such as advair, symbicort, dulera. Also, some people who have asthma and/or another lung disease such as chronic bronchitis, emphysema, or COPD may be prescribed a non-steroid inhaled medication which include name brands such as atrovent, spiriva, or intal.

If you are not having “asthma symptoms” you should not need to use your bronchodilator at all. However, if your asthma is under control you should continue using your “controller” medication.

How to Use the Metered Dose Inhaler with a Spacer


Preparing the Inhaler

  • Put the inhaler together (as needed). Most do not require assembly.
  • Inspect the spacer for foreign objects, if there is a valve, make sure it is intact and not damaged, torn, or missing.
  • Remove the cap from the mouthpiece. Make sure nothing is blocking the opening.
  • Attach the inhaler to the spacer. (specific medications should not be used with a spacer – such as Maxair, or QVAR. Consult your pharmacist or physician for additional medications).

Using a Metered Dose Inhaler with a Spacer

  • Shake the inhaler for several seconds. (*specific controller medications do not require shaking)
  • Prime the inhaler as needed – will vary depending on brand – “priming” is done to mix the medication with the propellant, to help prevent medication build-up and blockages, and ensure that the inhaler works properly by releasing a test spray into the air prior to use. Refer to the manufacturer’s insert included with the MDI.
  • Hold the inhaler upright with your index finger on top and thumb on the bottom, support the spacer with your other hand.
  • Exhale fully and gently through your mouth.
  • Position the spacer comfortably in your mouth, with your lips and teeth around the mouth piece.
  • Press down on the inhaler.
  • Inhale slowly and deeply for about 3 to 5 seconds as the medicine moves from the  spacer into your lungs.
  • Close your mouth, hold your breath for at least 10 seconds; then exhale.
  • Repeat dose(s) as ordered. Be sure to shake the inhaler before each puff or pressing down on the inhaler.
  • Wait 30 – 60 seconds between doses  – waiting between puffs allows the medication you breathed in to take effect by beginning to open your airways and give relief. With your lungs more relaxed and open, you will be able to breathe in the next puff of medication deeper to provide better relief of symptoms.
  • Wait at least 10 minutes when using two or more types of inhalers (such as bronchodilators, anticholinergics, corticosteroids). Typically,  FIRST use your bronchodilator (such as albuterol or xopenex) to open up or dilate the lungs, then use other long acting controller medications or combined inhaled medications such as inhaled steroid or non-steroid inhaled medications (such as  pulmicort, flovent, advair, symbicort, atrovent, or intal, etc.).

Special Instructions

  • Breathe out fully before pressing down on your inhaler.
  • Breathe in slowly and deeply.
  • Inhale slowly through your mouth, not your nose when using a spacer or holding chamber.
  • Press down only once when using your inhaler. Wait at least 30 seconds to 1 minute between each puff. This waiting between inhalations gives the previously inhaled medication “time to work” by dilating your lungs open and it gives time for you to “shake” or prepare your inhaler for another dose.
  • The medication is colorless and typically odorless.
  • Clean your MDI often (read manufacturer’s insert with product). The propellant used today can cause blockages at the point where the medicine comes out of the inhaler. Cleaning is easy! Typically remove the medicine canister from the holder and rinse warm or hot water through the holder to clear away any blockages. If you are unable to remove the medicine canister from the holder, use a Q-tip with isopropyl or rubbing alcohol to clean the opening where the medicine sprays out.
  • Refill your inhaler medicine as needed; do not wait until the canister is empty. Most inhalers do not have a “counter” built in – otherwise record the amount of puffs used on a sheet of paper or daily journal – the average is 200 puffs per canister – read the manufacturer’s insert included with your medication for more information or ask your your pharmacist.
  • When using a corticosteroid (steroid) inhaler or combination inhalers that contain a steroid, be sure to  “rinse and spit” after use to prevent mouth and throat irritation, or developing “thrush” (which is a growth of yeast on the tongue or throat) and other issues.
  • Contact your pharmacist or doctor right away if your inhaler or spacer is lost or broken.
  • Spacers or valved holding chambers can be used with most types of propellant based inhaled medications; clean your spacer/holding chamber regularly.

Caring for the Inhaler & Spacer

Keep your inhaler and spacer clean. Wash the curved mouthpiece and the spacer in warm, soapy water at least once a week. Dry carefully with a clean, lint-free cloth. Keep the cap on the mouthpiece when not in use. Do not share your inhaler with your family or friends. Certain types of inhalers require special cleaning methods – refer to the packaging insert provided with your medicine to properly clean it.

Always have a extra spacer on hand if possible.

Instructions on taking care of your spacer:

Click on the following:

Cleaning a Spacer or Valve Holding Chamber

When to Call the Doctor

Contact your doctor if you:

  • DO NOT get relief from using your inhaler or you need to use your inhaler more often;
  • Have shortness of breath or wheezing not relieved by your inhaler; or
  • Have weakness, increased heart rate, shakiness, difficulty breathing, nervousness, headaches, nausea or vomiting.

***It is important to follow all of your doctor’s directions and by having an Asthma Action Plan. If you have asthma, treatment may include routine use of a peak flow meter and avoiding things that make your asthma worse called “triggers”. A yearly flu vaccination and twice-a-year doctor check-ups will also improve your asthma severity and treatment.

***Note: Please discuss questions and concerns of your medications, either inhaled, pill, or liquid, with your physician, or pulmonologist (lung expert).

***Over-the-Counter Inhalers: In patients with persistent asthma, it is dangerous to self-treat with Over-the-Counter (OTC) inhalers rather than seeking medical care. The result of using the OTC inhaler may be inadequate and delay therapy, which can lead to worsening complications of asthma or even death that could have been prevented with proper treatment and diagnosis by a physician.

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