HoldingChambers2Press down on your metered-dose inhaler (MDI). A fine, medicated mist puffs out. Then, a split second later, it disappears into thin air.

That’s how fast you must coordinate using an MDI and breathing in the inhaler’s medicine. To effectively treat asthma symptoms using an MDI, you must inhale at just the right moment and just the right speed – but catching that fleeting dose in a slow, deep inhalation is often very difficult.

Studies show that less than one-fourth of medicine delivered by an MDI actually makes it into the airways. The rest ends up lost in air or stuck on the tongue, sides of cheeks or back of the throat.

So how to make your MDI work for you? Talk with your doctor about using a valved holding chamber – a handheld device that attaches to your MDI and captures the medicated mist as it sprays out. Using a one-way valve, the medication is trapped long enough inside the holding chamber to be inhaled at your own speed. Most importantly, it pulls out large particles of medication unable to make it into your airways, preventing them from settling in your mouth or throat.

Valved holding chambers are often confused with spacers, but the two devices are different. Both direct the medicine into the airways, but the holding chamber “holds” the medicine and allows users to inhale at their own speed.

Holding chambers are available for use with and without masks. Using a mask is often essential for children, elderly or handicapped people who cannot close their lips securely around a mouthpiece or who need to take several breaths to inhale the medication fully. Choose a mask that is big enough to fit over the user’s mouth and nose, and soft enough to seal tightly to the face.

National asthma treatment guidelines recommend valved holding chambers because research shows they help patients take their medication more easily. They are beneficial for anyone whose timing and inhalation reflex is a split second too slow.

Here are some how-to tips:

  • Before you insert the MDI into the holding chamber, shake and prime the MDI according to the medication’s patient instructions. If you need a second dose and your MDI instructions say to shake before each use, you don’t have to remove the holding chamber. Just shake the whole system.
  • When using a mask, attach it to the holding chamber first, then prime the MDI (according to package instructions) and insert it into the chamber. Place the mask firmly against the face, covering the mouth and nose.
  • Send just one dose of medication into the holding chamber at one time. After inhaling, follow MDI instructions about how long to wait before taking a second dose (if needed).
  • The holding chamber cannot suspend the medication forever, so begin inhaling as soon as you activate your MDI. If possible, take 4-5 seconds to inhale with a long, slow deep breath to move the medication deep into your lungs. Most adults can inhale from a chamber in one breath, while children may require 2-3 breaths; talk with your doctor for specifics.
  • It’s important not to inhale too quickly. Some holding chambers have a whistle that sounds off if you inhale too hard.
  • Carefully read and follow package instructions on how to keep the valved holding chamber clean. It should be washed at least once a week if used daily. Soak the holding chamber in a mild dishwashing detergent; some can go in the dishwasher (check package instructions), but masks should be washed by hand. Let the holding chamber air dry after washing – don’t use a drying cloth. Stand it on end so water droplets don’t settle on the side.
  • Pack your valved holding chamber with your bronchodilator inhaler and carry it with you.


This article is sponsored by Lupin Pharmaceuticals, Inc.