In the early years of inhalers, children often used an MDI by itself. However, today most children are likely to be prescribed a spacer (also called a holding chamber) with the MDI to make it easier for them to use.
The spacer, which comes in a variety of styles, acts as a medicine conduit between the inhaler and the mouthpiece held by the child. The spacer works to hold and slow down the spray ejected by the inhaler so a child can take more time to inhale the medicine deep into her airways.
The idea behind the spacer is that larger particles from the aerosol spray will attach to the walls of the device. These are particles that (without the spacer) would end up in your child's mouth and throat. The finer particles in the inhaler medicine then will make their way to your child's airways — and help her asthma symptoms.
The one-way design of a spacer prevents a child from breathing back into the device. The spacer also requires less coordination than using the inhaler alone: A child can breathe in the medicine after the inhaler is puffed — not at the same time it is puffed.
Types of Spacers
The most common — and frequently prescribed inhaler — is a plastic tube with a space for the inhaler at one end and a mouthpiece at the other. Children as young as five years should be able to use this type of spacer comfortably.
Spacers also are available with a mask at one end that can be used by infants and toddlers. The mask should be fit securely around the child's face so he gets the medicine that he needs from the inhaler.
Bag-type spacers have an inflated bag in which the inhaler is sprayed. As the child breathes in the medicine through the mouthpiece, the bag shrinks in size. This type of space may work better with preschoolers and kindergartners who might like breathing in and watching the bag shrink as they take their medicine.
The bag device's life is short, though: The bags may last from one month to a year, while a plastic cylinder tube-type could last years.
An air entrapment device is slightly different than a spacer. With the device, the child sprays the inhaler as he breathes in deeply. He then holds his breath, and then breathes out. Using a series of internal baffles, the device filters out the medicine's larger particles, and permits the medicine to get through the child's lungs, while removing the amount that goes into the mouth. The device's smaller size has made it more popular among teenagers.
Using the Spacer
Keep a few extra tips in mind when using the MDI with a tube-type spacer:
After removing the cap from the MDI and shaking it, insert the end of the MDI into the larger opening of the tube. (The canister bottom should be facing the ceiling.)
Holding the tube securely, have your child place the mouthpiece between her teeth and then close her lips around it.
Press the inhaler and have your child breathe in slowly for about 5 seconds.
Have the child remove the inhaler while holding her breath for 10 seconds.
Repeat if another dose is required from the inhaler.
Keep in mind that each dose requires one puff of the inhaler:in other words, your child should not press the inhaler twice to get two doses — and then breathe in. Instead, press the inhaler once and breathe in, and then press again for a second dose if needed.