Metered-Dose Inhaler Used with a Valved Holding Chamber (Spacer)

A metered-dose inhaler (MDI) is a pressurized canister of medicine that releases a medicated mist. Inhaled asthma medicines contain a gas that helps the medicine get into your lungs. Chlorofluorocarbon (CFC) depletes the ozone layer in our atmosphere. It has been replaced by hydrofluoroalkane (HFA). The medicine in HFA inhalers is the same as the medicine in CFC inhalers. It's the gas used to push the medicine out of the inhaler that is changing. The HFA inhaler looks just like a CFC inhaler, but is a little different. The spray comes out with less force, is warmer, and has a slightly different taste. It is not felt as much in the throat when inhaled, but you still get the right amount of medicine.

The valved holding chamber is a spacer device that can be used with the MDI. Examples of valved holding chambers are the AeroChamber or the OptiChamber. The chamber helps make sure the MDI is at the correct distance from your child's mouth and at the best angle. Your child can more easily breathe in the drug with one or more breaths, and not worry about coordinating the timing. It helps your child inhale more medicine into the lungs. The chamber can be used with or without a mask.

Before the first use, wash the valved holding chamber with warm soapy water. Do not rinse. Allow to air dry.

Attach the MDI to the valved holding chamber as follows:

  1. Remove the caps from the chamber and MDI.
  2. Shake the metered-dose inhaler vigorously.
  3. Insert the mouthpiece of the inhaler into the rubber-sealed end of the chamber.
  4. If the MDI has not been used before or if the MDI has not been used for a while, you must then "prime" the MDI. Do this by spraying several sprays of the medicine into the air. Each time you use the MDI, the next dose is drawn into a chamber inside the MDI. If the MDI has not been used or sits for a long time without being used, some of the medicine leaks out of the holding area. This means you will not get the full dose of medicine the next time it is used. Priming the MDI makes sure that you get the full dose of the medicine.
  5. Insert the mouthpiece of the inhaler into the rubber-sealed end of the valved holding chamber.

To use the MDI with the valved holding chamber and mask:

  1. Select the correct size mask for the patient (small, medium, or large) and attach to the mouthpiece end.
  2. Have your child stand or sit up straight.
  3. Put the mask to your child's face, covering both the nose and mouth. The mask must be pressed to your child's face to assure that the medicine can get to the child's lungs.
  4. Depress the MDI once.
  5. Have your child breathe in and out slowly through the valved holding chamber for at least 5 breaths.
  6. When additional puffs are prescribed by your healthcare provider, wait 1 minute and repeat.

To use the MDI with the valved holding chamber and mouthpiece:

  1. Have your child stand or sit up straight.
  2. Place the chamber into your child's mouth. Ask your child to breathe slowly in and out of the valved holding chamber several times.
  3. Depress the MDI once.
  4. Have your child breathe in as deeply as possible and then hold his breath for 10 seconds. For children unable to hold their breath, another method is to breathe in and out slowly for 3 to 5 breaths.
  5. When your provider prescribes additional puffs, wait 1 minute and repeat.

Tracking Doses

How to track doses for scheduled medicine used every day:

  1. Place a blank label around the boot of the MDI.
  2. Identify the number of puffs (actuations) available by reading the label on the MDI canister.
  3. Divide the number of available puffs by the prescribed number of puffs per day. (For example, 120 doses available divided by 4 puffs per day would equal a 30 day supply of doses.)
  4. Write the date on the label that you will need to refill the prescription. Allow a 5 day grace period. (For example if you started on 7/1, show a date 25 days later (30 day supply minus 5 days).

How track doses for medicine used as needed:

  1. Place a blank label around the boot of the MDI.
  2. Identify the number of puffs (actuations) available by reading the label on the MDI canister.
  3. Write down the start date and number of puffs available on the label.
  4. Make a hash mark for each puff used (include wasted puffs).
  5. Get a refill when 10 puffs are left.

Cleaning Instructions

  1. Remove mouthpiece cap and end cap from valved holding chamber by pulling them off.
  2. Separate the mouthpiece from the clear chamber by rotating the mouthpiece counter clockwise until it unlocks and pulls off.
  3. Remove the valve from the small clear posts on the end of the chamber.
  4. Wash all parts in warm water with a mild liquid soap. Rinse all parts (except chamber) with water. Shake out excess water an allow all parts to air dry.
  5. Reassemble all parts, making sure that the one-way valve is seated correctly on the small clear posts on the end of the chamber. Place mouthpiece over valve assembly then turn clockwise until it snaps in place.
  6. When replacing the end cap, line up the edges of the warning signal with the raised lines on the side of the end cap so the warning signal will fit into the proper space. Place on a hard surface and push down firmly to ensure end cap is firmly sealed.
  7. Replace the one-way valve when it becomes dried out and starts to curl. A new valve can be ordered by calling 800-962-1266.
Written by the Asthma Task Force at The Children's Hospital, Denver.
Published by RelayHealth.
Last modified: 2009-02-13
Last reviewed: 2008-12-29
This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.
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