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					Oxford Children’s Hospital




INHALER AND SPACER
    TECHNIQUE
   A guide for parents 2008
What is this leaflet about?
 This leaflet is for parents of children who have
  been diagnosed with asthma or wheeze associated
  with viral infection and need to use Metered Dose
  Inhalers (MDI’s) and spacers.
 It is based on up-to-date research.
 The information in this leaflet is to be used
  together with the teaching from your child's nurse
  to give you the best information on how to give
  inhaler medication to your child in hospital and at
  home.
 Ideally try and read this leaflet before you take
  your child home so that if you have any questions
  you can ask your child's nurse straight away.

What does an inhaler do?
Inhaled medications are the main treatment for
asthma and other forms of wheezing. The medicine
inside the inhaler is deposited directly into the
airways. This means that your child will need a
smaller dose than if the medicine was taken as a
tablet or liquid by mouth. It also means that there
are fewer side effects.

What are the different types of inhaler
medicines?
There are 2 main types of inhaler medicines: reliever
inhalers and preventer inhalers.
Reliever inhalers work quickly to relax the muscle in
the airways. This opens the airways wider and eases
the symptoms. The reliever medicines are also called
bronchodilators, because they dilate (widen) the
airways. There are a few different types of reliever
medicines. Your child is most likely to be sent home



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from hospital with Salbutamol, which usually comes in
a blue inhaler.
Preventer inhalers usually contain steroid medicine.
Steroids help to reduce inflammation in the airways.
The steroid medicine does not work immediately and
usually takes 7-14 days to take full effect.

What inhaler medicine will my child have?
If your child has recently been diagnosed with asthma
or post-viral wheeze it is likely that you will only have
been given a reliever inhaler. Your child will be
monitored by your GP who may change the
medication if needed.
What inhaler and spacer device will my child have?
There are different types of inhaler devices that
deliver the same medicine. The type you will be given
for your child by the Children’s Hospital is called a
Pressurised MDI (Metered Dose Inhaler) with a spacer.
The MDI is the most commonly used inhaler device
and one that you may have seen before. It contains a
pressurised gas that propels a set dose of medicine
with each puff. Other devices available contain a dry
powder and are suitable for older children (usually 8
years or above).
The spacer device holds the dose of medicine from the
MDI whilst your child breathes it in. There is a valve
at the mouth-end, which controls the release of the
medicine. The advantages to using a spacer are that:
   More than twice as much medicine reaches the
     lower airways than using an MDI alone.
   You don't need good co-ordination between
     pressing the top of the inhaler to release a puff
     and breathing it in, so it is easier to use




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If used correctly, the inhaler and spacer can provided
as much reliever medicine as a nebuliser, which
means it can be used for emergency treatment.
Older children (usually those over 3 years old) who
are able to open the valve with their breathing should
use a spacer with a mouthpiece.
Younger children and infants who are unable to use
the mouthpiece effectively should use a spacer with a
soft facemask
There are different types of spacer devices that can be
used with MDI. The type spacer provided by the
Children’s Hospital is called an Aerochamber.

How do I use my child's inhaler and spacer?
Before using the spacer for the 1st time:
 Wash the spacer in hot soapy water (to prevent
   the medicine sticking to the walls of the spacer.)
 Allow the spacer to air dry. Do not dry with a
   cloth.
 Wipe the mouthpiece or mask with a damp cloth to
   remove any traces of washing-up liquid.
Before every use of the spacer:
 Check the expiry date of the inhaler.
 Make sure the spacer has been washed within the
   last 4 weeks (the manufacturers advise weekly,
   but monthly is better.)
 Clean the mouthpiece of the inhaler with a damp
   cloth.
 Puff 1 dose of the inhaler into the spacer to form a
   lining to prevent the prescribed dose sticking to
   the walls of the spacer.




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How to give the prescribed dose to your child:
Spacer with facemask (usually for children <3 years)
   The spacer with facemask is only for young
    children who cannot manage the spacer with
    mouthpiece.
   Prepare your child by reducing anxiety in your
    normal way (for example cuddles, favourite music
    or story.)
   Position your child so they are comfortable.
   Place the spacer in a horizontal position or tilted
    slightly down, with the child in a sitting position or
    lying down.
   Hold the facemask against your child’s face making
    sure that it is well sealed around their moth and
    nose. There should be as little delay as possible
    between putting the puff into the spacer and your
    child inhaling it. This will ensure that your child
    gets the correct amount of medicine.
   Shake the inhaler well to mix the medicine before
    each puff and allow 30 seconds between puffs for
    inhaler to refill.
   Attach the inhaler to the non mouth-end and press
    the inhaler top to give 1 puff only. Your child will
    not get all of their medicine if more than 1 puff is
    put in the spacer at the same time.
   Allow your child to take about 6 normal breaths via
    the spacer. You may find it helpful to count aloud
    with your child.
   If your child is very distressed and un-cooperative
    then try only 2-3 good breaths. This will give
    them most of their medicine.
   If your child needs more than 1 puff, remove the
    spacer and allow your child to breathe normally for




                                                         5
    20-30 seconds between puffs and repeat the
    procedure.
   If your child is using a steroid preventer inhaler
    e.g. Beclomethasone, wash your child's face with
    warm water after use. This will remove any
    unwanted traces of steroid from the skin.

Spacer with mouthpiece (for most children over 3
years)
 The spacer works better without the facemask and
   should be used should be used with the
   mouthpiece where possible. Your child can sit or
   stand whilst using the space.
 Their breathing should be as relaxed as possible.
   Slow deep inspirations are best.
 Ensure your child does not push their tongue
   through the mouthpiece as this may reduce the
   amount of medicine they get.
 If a whistle sound is heard whilst breathing in
   encourage your child to slow their breathing rate
   down. (Aerochamber spacer only)
 If your child is using a steroid preventer inhaler
   e.g. Beclomethasone, ensure your child rinses
   their mouth after use. This will remove any
   unwanted traces of steroid from their mouth.




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Storage and disposal of your child's inhaler
 Store your child's inhaler at room temperature,
   away from direct light.
 Keep the lid of the inhaler on at all times when not
   in use.
 Replace all inhalers before they expire.
 Replace your child's spacer every 12 months.
 You can dispose of your child's used inhalers at
   your local pharmacy.
 Ensure your child has a repeat prescription from
   your GP.
 Plan in advance to ensure you do not run out of
   inhalers, especially over holidays.

References:
Oxford Radcliffe Trust standard for the administration
of inhaled medication to children (April 2003.) (This
guideline is based on current research findings
including the NICE (National Institute for Clinical
Excellence) (2000) guidelines for using inhalers in
children).
Further information or support:
National Asthma Campaign, Providence House,
Providence Place, London N1 0NT 08457 01 02 03
www.asthma.org.uk




                    Authors: Morag Masson and Carla McMahon
                                               Drayson Ward
                                                    Version 4
                    Reviewed November 2008 (Dr Jeremy Hull)
                                  Next review November 2010




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