A Spacer is a plastic container that is used with a metered-dose inhaler (MDI) to inhale medication into your lungs. Using a Spacer makes dosing easier and more effective, reducing side effects like oral thrush. It has an opening at one end to insert your inhaler and a mouthpiece or mask at the other end for you to breathe in your medicine.

Spacers should be cleaned regularly and replaced as per the manufacturer’s instructions. There is more than 1 type of Spacers and instructions on how to use them are described below.⁵

How to use a Spacer:⁵

1. Remove the cap, shake the inhaler and insert it into the Spacer.
2. Place the mouthpiece between your teeth and seal it with your lips, but do not bite.
3. Start breathing in and out slowly and gently. You will hear a clicking sound as the valve opens and closes.
4. Once your breathing is steady, press one puff of your inhaler and continue to breathe in and out several times.
5. Remove the Spacer from your mouth.
6. Repeat steps 1-5 for extra puffs.

A Peak Flow Meter looks like a small plastic tube which you breathe into as hard and fast as you can. On the side, a marker measures your peak flow rate, which is a measure of how fast you breathe air out of your lungs using maximum effort, and this is used to check if your asthma is under control.^{3, 5}

How to use a Peak Flow Meter:

1. You should measure your peak flow rate every morning and evening before you use your inhaler.
2. Stand or sit up straight.
3. Push the pointer/marker on the peak flow meter to base or zero.
4. Take a deep breath in.
5. Place the mouthpiece between your teeth and seal it with your lips, but do not bite. Take care not to cover or block the pointer with your finger
6. Blow as hard and fast as you can (a short sharp breath).
7. Do this three times and record the highest reading on your daily Asthma/Peak Flow Diary.

A nebuliser is a device which changes liquid medication into a very fine mist which is then breathed in through a mask or mouthpiece, reaching even the smallest parts of the lung.

Nebulised therapy is often used when:

• High doses of reliever medication are needed in emergencies such as an asthma attack.
• A child, disabled or special needs person, or someone with conditions such as arthritis or poor eyesight cannot use an inhaler.
• The required medicine is not available in any other format.11, 12

Due to advances in the types of inhalers and spacers available today, there is less need for nebulised therapy; however, in certain circumstances, it may be prescribed.

Patients with severe asthma often are prescribed a nebuliser for home use.^{5, 12}

Nebulisers can also be used in the tests that are run by the doctor to diagnose asthma, alternatively, it can be used for the treatment of other conditions, as occasionally high doses of corticosteroids or antibiotics need to be delivered into the lungs.
A nebuliser can be used by all ages, as babies and small children could use a mask and older children and adults could receive the medication via either a mask or a mouthpiece.¹²

Not all nebulisers are the same. To recommend the use of a specific nebuliser, your doctor will also look at the type of medication he is prescribing and which machine will deliver the best treatment. The size of the medication particles, the output of the nebuliser, how long the medication needs to be administered for and how much of the drug could get lost during treatment, are some of the points he will look at before recommending a specific type of nebuliser.¹¹

Here are some of the nebulisers that are being used to treat asthma:

A nebulising session could last 5 to 10 minutes and the following are helpful tips on what to do during such a session:¹²

• If you’re using a mouthpiece, seal your lips around it and breathe through your mouth, not your nose.
• If you’re using a facemask, place it over your mouth and nose
• Sit up as straight as you can.
• Try to take normal, calm breaths.

To get the best performance from your nebuliser, you need to take proper care of the machine after treatments:

• Cleaning – as nebulised medicine is delivered directly to the lungs, it could cause infection if the equipment is or becomes contaminated. A nebuliser should be used for only one person, carefully cleaned and disinfected regularly. Cleaning nebuliser equipment involves getting rid of medication residue as well as dirt and germs. Always follow the instructions you received from the manufacturer when cleaning the machine.¹¹
• Maintenance – regularly check the tubing for holes or kinks. Masks, mouthpieces, filters and tubing needs to be changed regularly as per the manufacturer’s instructions.₁₁
• Technical Services – Nebulisers must be serviced regularly by the manufacturer or by the provider from whom you obtained the machine. Make sure you are aware of when, where and how often this needs to be done.¹¹