Holding Chambers and Spacers for Asthma

Valved holding chambers and spacers are devices that help people with asthma use their inhalers better. These tools make sure the medicine from the inhaler gets to the lungs, where it’s needed, instead of just staying in the mouth or throat.

The devices extend the mouthpiece of a pressurized metered-dose inhaler (MDI). They help direct the cloud of medication toward the throat. This reduces the amount of medication released into the air or inside the mouth. The devices can also help you avoid problems like sore throats or infections.

What is a spacer?

A spacer is a simple tube that you attach to an inhaler. It holds the medicine for a short time after you press the inhaler, so you can breathe it in more easily. This gives you more time to inhale the medicine properly, making sure it gets into your lungs. Spacers are helpful for children or anyone who finds it hard to use an inhaler the right way.

What is a valved holding chamber?

A valved holding chamber is a type of spacer that has a special one-way valve. This valve traps the medicine stays inside the chamber until you breathe it in. It helps release the medicine over a period of a few seconds, so you can get more of it into your lungs. It’s a more controlled way to use an inhaler, making the medicine work better.

Holding chambers are available for use with and without masks sized for infants to adults.

Why use a valved holding chamber or spacer with the inhaler?

Inhaled asthma medications treat inflamed and congested airways. But getting the medicine deep into the lungs depends on the user’s ability to correctly use the inhaler. The user must position and depress the MDI a split second after beginning a slow, deep inhalation.

Sounds easy, right? But when the dose of medicine leaves the inhaler at about 60 miles an hour, a lot can be lost in the process. Maybe the medication particles gets stuck to the top of the tongue, sides of the cheeks or the back of the throat. Or maybe they get swallowed before making it to the airways.

Valved holding chambers and spacers help you use your inhaler correctly. More of the medicine can get to your airways and lungs, and thus be more effective in controlling your asthma. The devices allow you to streamline and improve drug delivery, whether it’s a quick-reliever medication, inhaled steroids or other inhaled medication.

How do you use a valved holding chamber or spacer?

Using a valved holding chamber or spacer may take some breathing practice in order to use it correctly. Keep the device next to where you keep your inhaler, so you don’t forget to use it.

Step-by-step instructions

1 – Always read and follow the manufacturer’s instructions.

2 – Check the chamber’s insertion port to make sure it is clean and free of any small particles. Shake and prime the MDI according to instructions, then insert the mouthpiece into the holding chamber port.

3 – Exhale away from the mouthpiece, then place the chamber mouthpiece between your teeth. Keep your tongue out of the way and close your lips around it. Actuate the inhaler, inhale slowly and deeply, then hold your breath for 10 seconds. Remove the chamber from your mouth, exhale, and repeat the entire process for the second puff. (You can leave the MDI in place for shaking, if necessary.) Never spray two puffs of medication into a holding chamber at one time. Ask your physician or pharmacist about how much time to allow between puffs of medication.

4 – Clean the holding chamber according to the manufacturer’s instructions or when the unit becomes cloudy or filmy inside. Make sure it has a chance to air-dry completely before the next dose is needed.

5 – Replace disposable parts as recommended to avoid bacterial growth.

6 – Use a permanent marker to note the purchase date of the holding chamber on the side of the device. Discard your unit when advised in the package instructions or if the unit fails to operate as expected.

Many valved holding chambers are fitted with a universal rubber end piece to accommodate the MDI without having to remove the canister from the boot.

Some inhalers have built-in spacers. These are designed, tested and approved by the U.S. Food and Drug Administration (FDA) as a unit. Add-on units may require you to remove the MDI canister from the inhaler boot and insert it into a special port. This may or may not affect product performance and medication delivery.

Talk with your doctor, respiratory therapist or certified asthma educator to learn more about these devices.

Using a face mask with a valved holding chamber or spacer

Place the mask tightly on the face and breathe normally. When the mask fits properly, you will see the valve open and shut when taking a breath. Actuate the MDI when taking a slow, deep breath. Keep the chamber in place while breathing in and out several times.

For a second dose (if prescribed), remove the holding chamber mask from the face, shake the MDI/chamber unit, replace the mask on the face and repeat the activation/inhalation process.

How to clean a valved holding chamber or spacer?

Your valved holding chamber and spacer should be cleaned regularly – at least once a week if used every day. Cleaning removes the normal accumulation of medication particles on the valve and inside walls. They can also collect dust mites and mold – allergens that often make your asthma symptoms worse.

Washing can also help combat static electricity. Static electricity can cause large and small particles to collect in the chamber as well. This can decrease the amount of medicine that gets into the lungs. It’s important to use a valved holding chamber made with antistatic materials. Follow the recommended cleaning process to reduce static charge.

Step-by-step instructions

First, always check your device for cracks, debris or damage before each use. Clean it regularly according to the manufacturer’s instructions – usually once a week if you’re using it daily. Some units require washing before the first use. 

Cleaning instructions will vary from one brand to another. These are the most common steps: 

1 – Disassemble

Follow the package instructions for taking the holding chamber apart. This may include removing the soft plastic port where the inhaler is inserted, the mouthpiece cap, and sometimes the mask. Do not take the valve section apart, unless instructed.
➤ Quick tip: Always remove your metered-dose inhaler (MDI) from the holding chamber before cleaning. MDIs require a different cleaning procedure, usually without water.

2 – Soak

Prepare a large bowl with a solution of lukewarm water and liquid dishwashing detergent. (Washing with water alone causes an electrostatic charge to develop.)  Soak the device and all its pieces for 15 minutes.
➤ Quick tip: Choose a bowl large enough for the chamber to rest fully in the water.

3 – Rinse

Rinse all the pieces in clean water. 
➤ Quick tip: You can reduce the static charge of non-antistatic holding chambers and spacers by washing the device in a dishwashing liquid solution. Then let it air dry without rinsing. This is not as effective as using antistatic materials, however.

4 – Air Dry

Shake off any excess water. Place the pieces on a clean, lint-free cloth or drying rack to air dry. Rest the chamber section on its end (vertically), rather than on its side.
➤ Quick tip: Do not towel-dry, as that can build up static charge.

5 – Reassemble

When all the pieces are completely dry, carefully put them back together according to the instructions.

Can you put spacers and valved holding chambers in the dishwasher?

Most manufacturers say their spacers and valved holding chambers are dishwasher safe. Follow the instructions carefully. Most should not be put through a dry cycle or washed in water hotter than 158 degrees.

Other instructions say not to wash holding chambers with extremely dirty dishes or in heavy wash cycles.

Are valved holding chambers and spacers covered by insurance?

Some insurance plans will cover the cost of valved holding chambers and spacers for at least one year. But some won’t. Contact your insurance provider to find out for sure.

The good news is the cost of valved holding chambers is not very high. They are around $10-15 apiece. If you do have to pay out of pocket, they are affordable. And they do last you some time.