Your Guide to Using Inhalers and Spacer Devices

There are two main types of inhaler: reliever and preventer:

• Reliever medication (use when needed) – usually a blue inhaler.
  This relieves the symptoms of cough and wheeze by relaxing the tight muscles around the airways allowing the airway to open wider, making it easier to breathe.
• Preventer medication (need to use regularly) – usually brown, beige, orange or purple inhaler. This is a steroid inhaler and helps to prevent asthma symptoms by reducing the amount of swelling and inflammation in the airway and stopping them from being so sensitive. a is usually taken twice a day and should not be stopped without medical advice. Remind your child to clean their teeth or rinse their mouth with water after using the preventer inhaler, or if using a mask with the spacer remember to wipe your child’s face with a damp flannel. This will prevent your child from having a sore mouth.

Metered dose inhaler (MDI): These inhalers must always be administered with an age-appropriate spacer device.

These include:

• Large volume spacer with mask (Volumatic)
• Large volume spacer with mouthpiece (Volumatic)
• Spacer with mask for young children (AeroChamber Plus)
• Spacer with mouthpiece for young children (AeroChamber Plus)

The instructions for use are as follows, for each type of spacer.

Remember: Only release one puff of medicine into the spacer at a time. If more than one puff is released into the spacer, the droplets of spray stick together and coat the sides of the spacer so the child receives less of the medication. Spacers should be washed once a month in warm soapy water and allowed to dry. Wipe the mouthpiece only to ensure it is free of detergent. This helps to prevent the medication sticking to the sides of the spacer.

1. Remove the cap from the inhaler, shake it and insert it into the back of the spacer.
2. Place the mask of the spacer over your child’s mouth and nose and make sure there is a good seal.
3. Tilt the spacer to a 45 degree angle.
4. Encourage your child to breathe in and out slowly and gently.
5. Once his or her breathing pattern is established, press the inhaler canister once to release one puff of medicine. Keep the spacer in the same position as your child continues to breathe slowly in and out five more times. If he or she is breathing fast, the breaths will be shallow. In this case aim for 10 breaths to each puff of medicine.
6. To give another dose, wait at least 30 seconds to one minute, then repeat steps 1 – 5.

1. Remove the cap from the inhaler, shake it and insert it into the back of the spacer.
2. Put the mouthpiece in your child’s mouth and make sure there is a good seal of his or her lips around the mouthpiece.
3. Encourage your child to breathe in and out slowly and gently.
4. Once his or her breathing pattern is established, press the inhaler canister once to release one puff of medicine. Keep the spacer in the same position as your child continues to breathe slowly in and out 5-10 times. If your child is breathing fast, the breaths will be shallow. In this case aim for 10 breaths to each puff of medicine. If the spacer is held horizontally, the valve will be in the open position. This will ensure your child receives the dose of medicine.
5. To give another dose, wait at least 30 seconds to one minute, then repeat steps 1 -4.

1. Remove the caps from the inhaler and spacer. Shake the inhaler and insert it into the back of the spacer.
2. Place the mask of the spacer over your child’s mouth and nose and make sure there is a good seal.
3. Encourage your child to breathe in and out slowly and gently.
4. Once his or her breathing pattern is established, press the inhaler canister once to release one puff of medicine. Keep the spacer in the same position as your child continues to breathe slowly in and out five more times.
5. To give another dose, wait at least 30 seconds to one minute then repeat steps 1-4.

1. Follow all the steps as for the spacer with mask, but only use the mouthpiece. Ensure your child’s lips are sealed around the mouthpiece and make sure when taking breaths that there is not a whistling sound, as this indicates the breaths are too brisk and the medication will not be administered correctly.

The following inhaler devices are self-administered.

Your healthcare professional will prescribe the most appropriate inhaler device according to your child’s age and ability.

1. Unscrew and lift off the cover. Hold the Turbohaler upright and twist the grip forwards and backwards as far as it will go. You should hear a click.
2. Breathe out gently, put the mouthpiece between your lips and breathe in as deeply as possible, then hold your breath for 10 seconds. Even when a full dose is taken there may be no taste.
3. Remove the Turbohaler from your mouth and breathe out slowly.
4. Replace the cover. To take another dose, repeat steps 1-3.
   When a red line appears at the top window of the device, there are approximately 20 doses left. Some Turbohalers have a dose counter to tell you how many doses are left in the inhaler.

1. Hold the outer casing of the Accuhaler in one hand whilst pushing the thumb grip away with the thumb of your other hand until a click is heard.
2. Hold the Accuhaler with the mouthpiece towards you, then slide the lever away until it clicks. This makes the dose ready for inhalation and moves the dose counter on.
3. Breathe out gently, then holding the device horizontally, put the mouthpiece in your mouth and suck in quickly and deeply.
4. Remove the Accuhaler from your mouth and hold your breath for 10 seconds, or for as long as it is comfortable.
5. To close, slide the thumb grip back towards you until it clicks.
6. For a second dose, repeat steps 1-5. The counter on top of the Accuhaler tells you how many doses are left. Numbers 5-0 will appear in red, to warn you when there are only a few doses left.

1. Shake the inhaler, hold it upright and open the cap.
2. Breathe out gently. Hold the inhaler upright, put the mouthpiece in your mouth and close your lips and teeth around it. Do not block the air holes on top.
3. Breathe in steadily through the mouthpiece and don’t stop breathing in when the inhaler ‘puffs’, continue taking a deep breath. You should hold your breath for about 10 seconds, or as long as is comfortable. Remove the inhaler from your mouth.
4. After use, hold the inhaler upright and immediately close the cap. For a second dose wait approximately 30 seconds, then repeat steps 1-3. Only use the device for the number of doses on the label, then start a new inhaler.

1. Remove the mouthpiece cover. Hold the Autohaler upright and push the lever right up. Shake the inhaler. If this is a new inhaler or you have not used it for two weeks or more, you must test it is working by releasing two puffs of air.
2. Breathe out gently. Hold the inhaler upright, put the mouthpiece in your mouth and close your lips and teeth around it. The air holes at the bottom must not be covered by your hand.
3. Breathe in steadily through the mouthpiece and don’t stop breathing when the inhaler ‘clicks’, continue taking a deep breath. Then hold your breath for about 10 seconds, or as long as it feels comfortable. Remove the inhaler from your mouth.
4. Lower the grey lever.
5. To take another dose, wait approximately 30 seconds, then repeat steps 1-4. Only use the device for the number of doses on the label, then start a new inhaler.

1. Remove the mouthpiece and shake the inhaler. Hold the Clickhaler upright.
2. With your thumb on the base and a finger on the coloured button, press the dosing button firmly once until it clicks, then release.
3. Breathe out and put the mouthpiece between your lips and teeth, sealing your lips around the mouthpiece.
4. Breathe in steadily and deeply. Remove the Clickhaler from your mouth and hold your breath for about 10 seconds, or for as long as is comfortable, then breathe out slowly.
5. To take another dose, keep the Clickhaler upright and repeat steps 1-4.
6. The dose counter window on the back of the Clickhaler tells you how many doses are left in the device. A red warning appears when there are 10 doses left. When the Clickhaler is empty the device locks and can no longer be used. It should then be discarded.

If you have any further queries please contact the Paediatric Respiratory nurse specialists on 01473 702196.

Asthma UK Helpline: 0300 222 5800
Monday to Friday, 9am-5 pm
Website: www.asthma.org.uk