Then take your dose as prescribed. Low resistance inspiratory and expiratory valves open up freely, … Remove the medication canister from the mouthpiece. Be sure to clear medication build-up from the spray nozzle. How to use a spacer and facemask with your baby. If the results of earlier studies2,3 hold true, a 5% rate of potential cross-contamination might not be acceptable, given the high-volume use of MDIs, the frequency of repeated exposures of MDIs to patients several times each day, and the heightened risk to immunocompromised patients. Take the mouthpiece of the spacer out of their mouth and, with their mouth closed, ask them to hold their breath for up to 10 seconds, or for as long as they comfortably can. An effective infection prevention strategy, therefore, is a systematic, scheduled decontamination regimen conducted to agreed standards. If your child has used an inhaler that contains steroids, rinse their mouth out with water or brush their teeth to avoid side effects. "Shared metered dose inhalers among multiple patients: can cross-contamination be avoided?" This is because a spacer slows the medicine down as it comes out of the inhaler, so more of it gets taken down into your lungs. The MDI is a pressurized canister of medicine in a plastic holder with a mouthpiece. Keep your spacer away from dust and liquids. Press the canister on the inhaler once, and encourage them to breathe in and out slowly and steadily into the spacer five times. Put the canister in the actuator and make sure it fits firmly. When you’ve finished, take the inhaler out of the spacer and replace the caps on the inhaler and the spacer. Spacers should be checked by your doctor, pharmacist or nurse every 6-12 months to check the structure is intact (e.g. Check there’s nothing inside the mouthpiece, Put the inhaler into the end of your spacer, with the indent for your nose pointing upwards, Put the mouthpiece between your teeth and lips, making a seal so no medicine can escape, Sit or stand up straight and slightly tilt your chin up as it helps the medicine reach your lungs, Press the canister to put one puff of your medicine into the spacer, Breathe in and out slowly and steadily five times through the mouthpiece, Breathe out gently and slowly away from the inhaler and spacer until your lungs feel empty and you feel ready to breathe in, Put the mask on your face to make a seal over your nose and mouth, Press the canister on the inhaler once and breathe in slowly and steadily until your lungs feel full. How often should spacer devices for inhalers be cleaned? "Bacterial contamination of spacer devices used by asthmatic children." Your doctor, asthma nurse or pharmacist should show you how to use your inhaler and spacer properly and check your technique at your annual asthma review. There are several different brands of spacer that fit different inhalers and are available on prescription (including Volumatic, AeroChamber, Able Spacer, Space Chamber Plus, and Compact Space Chamber Plus). Do NOT use water to wipe the dry powder inhaler because the powder is sensitive to moisture. Keeping your spacer clean will help you to get the full benefits of your asthma medicines each time you use it. However, there are data showing that this risk is diminishingly small with the reuse of metered dose inhalers (Matt). Always speak to your GP, asthma nurse or pharmacist if you’re not sure whether you’re using your spacer and inhaler properly. Then repeat the steps. There are two breathing techniques you can use with your spacer. “When Emelia was first given an inhaler the asthma nurse at the doctor’s surgery showed me how to use it with a spacer which has a baby mask. Wash the mouthpiece, cap, and spacer with warm, soapy water. However, using personal inhalers is a reasonable first-line measure to prevent cross-infection.” • Should patients who forget to bring their own respiratory devices to clinic not have their technique assessed because of the risk? Don’t wipe it or you might create static that makes the medicine stick to the sides. Clearly, all respiratory devices have the potential to become colonised, although not always with common pathogens. Cuddle your baby on your knee or cradle them in your arms. You can also buy them from pharmacies. I have included a quote from one of the references that discusses this issue (Richardson). This makes the device easier to use and helps get the medication into your lungs. using a spacer with a facemask on your baby or child, Copyright © Asthma UK and British Lung Foundation Partnership 2021, Spacers are large, empty devices (or tubes) that are usually made out of plastic. Journal of Asthma 42.3 (2005): 169-172. Spacers with facemasks can be used with babies or with younger children who find it hard to use an ordinary spacer with a mouthpiece. VAT number 648 8121 18. I hope this information is of some help to you and your practice. If their healthcare professional has recommended the ‘tidal breathing or multiple breath’ technique, here’s how to do it: If their healthcare professional has recommended the ‘single breath and hold’ technique, here’s what they mean: If your child has been prescribed a second puff, remove the spacer from their mouth. Your spacer should be replaced at least every year, especially if you use it daily, but some may need to be replaced sooner – ask your GP, asthma nurse or pharmacist if you’re unsure. References: REFERENCES: 1. When you’re not using your spacer, storing it properly will help to keep it in good condition, helping you or your child to get the best from your asthma medicine. I am hoping you can help me with the safety of cleaning spacer devices. You can scrub the outside of the spacer and the mouthpiece, Leave it to air-dry as this helps to reduce static (an electrical charge that builds up) and prevent the medicine sticking to the inside of the spacer, When it’s completely dry, put your spacer back together ready for use. Using a spacer helps the medicine get straight to your lungs. An asthma inhaler is a handheld device that delivers medication straight into your lungs. You can also speak to an asthma nurse specialist by calling our Helpline on 0300 222 5800 (9am – 5pm; Mon - Fri), on WhatsApp, or by emailing our asthma nurses directly. Check there’s nothing inside the mouthpiece, Ask your child to slightly tilt their chin up as it helps the medicine reach their lungs, If the spacer has a valve, make sure the valve is facing upwards. 4: The inhaler and spacer device should be held between the index finger and thumb. Spacer devices are attachments to the mouthpieces of pressurised metered dose inhalers (pMDIs), and range from tube spacers with a volume of <50 mL to holding chambers with a volume of 750 mL. Spacers reduce the small risk of side effects if you’re taking preventer medicine. Where required follow the package instructions with respect to dismantling and cleaning as this may differ from one spacer device to another. Using A Spacer With Inhaler Dr. Mahler: The pharmacist at the local drug store told me that I should use a spacer with my inhalers. Because some medication and moisture from your breathing can remain in the spacer, the device needs to be cleaned frequently. If it’s a new spacer, clean it before you use it for the first time, then once a month afterwards. (See 'Spacer devices' below and 'Dry powder inhalers' below.) 30. All depends on how often it is used if your Volumatic Spacer Asthma UK is normally used on a daily basis it should be cleaned at least twice a week and should be replaced for a new Volumatic Spacer Asthma UK every 12 month’s. You get the drugs faster -- and with fewer side effects -- … If a hospital decides to use a common MDI canister protocol, the Association for Professionals in Infection Control and Epidemiology (APIC) recommends that the facility carefully analyze its processes to ensure that handoffs between patients are not inadvertent sources of microbial transmission. I think there is a finite risk of infection despite efforts to clean the spacer. Watch our video to help you master the ‘single breath and hold’ technique. There is a benefit from the standpoint of utilization of healthcare resources in the reuse of devices. Gently clean it using a detergent, such as washing-up liquid. Clean your press-and-breathe inhaler and spacer at least once a week to help keep medication from building up on them. • Should clinics withdraw particular types of inhaler if companies cannot provide adequate stocks of placebos, even if this reduces patient choice and possibly compliance? I could not find a specific recommendation with respect to the reuse of spacers in a clinical setting. We present an extensive review of the literature to date pertaining to the rationale for using a spacer/valved holding chamber (VHC) to deliver inhaled therapy from a pressurised, metered-dose inhaler, a discussion of how the properties of individual devices may vary according to their physical characteristics and materials of manufacture, the potential … “As she got older, she learned to take her inhaler with a bigger mask and then just a spacer. There is no evidence of specific viral assays with such devices, and I think most patients would be uncomfortable with sharing this type of equipment. Older children usually prefer to sit or stand by themselves. You can check your inhaler technique with your doctor, practice nurse or pharmacist. Your child’s GP or asthma nurse should show you how to help them use their inhaler and spacer. Getting the most out of your inhaler Ask your doctor, pharmacist or asthma & respiratory educator to: If you find it difficult to use the spacer with a young child, you’re not alone! All reprocessing of items should be subject to an audit trail for quality control. As with many decisions in medicine, you are balancing the risk with the benefit. Inhaled respiratory medications are often taken by using a device called a metered dose inhaler, or MDI. Hold the inhaler upright and take the cap off. Help with asthma research and information, The Asthma UK and British Lung Foundation Partnership, How to clean and store your asthma spacer. This also reduces the risk of voice changes and oral thrush: a fungal infection that can be a side effect of asthma inhalers, particularly in children. Cleaning the MDI — Metered dose inhalers must be cleaned on a regular basis to prevent medication build up and blockages. It can be difficult to use them correctly as you need to breathe in at exactly the same time as you press down on your inhaler to release the medicine. Asking patients to bring in active drug inhalers to test technique raises concerns of overdosing. no cracks) and the valve is working. A spacer is a tube that attaches to the inhaler and holds the medication until you can breathe it in. Tips and tricks for storing your inhaler The inhaler is a device that delivers puffs of medication into the air so a person can breathe in the medicine. Asthma UK expert nurse Caroline demonstrates how to properly take care of your asthma spacer. Another alternative is to use a spacer with your metered dose inhaler . They can check your technique to make sure you’re getting the most from your medicine. Clean the inhaler thoroughly and frequently: Remove the metal canister and cleanse the plastic case and cap by rinsing thoroughly in warm, running water. Read our advice on using, cleaning and storing your spacer. They help you get the best from your asthma medicine if you use a metered dose inhaler (MDI), Using a spacer makes it easier to get the right amount of medicine straight to your lungs, where it’s needed. I think the risk is extremely small with thorough cleaning and particularly with the use of 70% isopropyl alcohol. You also need to breathe in very slowly and deeply. Using a spacer can also reduce the risk of side effects from your medicine. Ask them to put their lips around the mouthpiece of the spacer to make a tight seal and begin breathing in and out. Getting your child to take inhaled medicine is the most important way to reduce their asthma symptoms and the risk of an asthma attack. • Does potential cross-infection pose a greater risk to patients than not assessing inhaler technique and drug delivery? Always follow the manufacturer’s instructions. However, there are data showing that this risk is diminishingly small with the reuse of metered dose inhalers (Matt). Registered office: 18 Mansell Street, London, E1 8AA. She’s really good at using her inhaler with a spacer.” – Maria, mum to Emelia, aged 9. If you have a baby or young toddler, sit them on your lap facing you so you can keep eye contact. Here is a way to disinfect the mouthpiece and cup every other day. Spacers should really be washed every week - as you use your inhaler the inside becomes sticky with the powder residue - this is turn can stop the full amount of drugs getting into your lungs. If you carry your spacer in your bag, keep it in a sealed purse or small bag so it doesn’t get scratched, and so small objects don’t get stuck inside it. Then repeat the steps. 4/23/2015 Metered dose inhalers (MDIs) deliver a dose of medicine in a fine spray (aerosol) form. Is this an appropriate procedure in 2015? Frequently Asked Questions How often should the chamber be cleaned? The spacer device also helps to slow down the aerosolised particles … Wait 30 seconds to a minute and shake the inhaler again. You fix your inhaler on one end of the spacer, and use the mouthpiece at the other end. Enhances your treatment. Wipe the mouthpiece of your dry-powder inhaler with a dry cloth at least once a week. Another discussion of the reuse of metered dose inhalers is provided below (Grissinger): When sprayed, it gives a reliable, consistent dose of medication. Your baby will be aware if you’re anxious. A spacer device is a large plastic container, often in two halves that click together. There are two different breathing techniques a child can use with their spacer. Don’t rinse the bubbles off, just let it air dry. Reassure your child by pretending to take the medicine yourself or giving it to a favourite toy. Only a small number of brands of spacer are dishwasher safe, so check the instructions on the label, Be careful not to scrub the inside of your spacer as this might affect the way it works. Mix a solution of 1 part distilled white vinegar and 3 parts warm tap water in a clean bowl. Richardson, M. "Risk assessment and reuse of placebo respiratory equipment." How does a spacer help me to manage my asthma better? Puffers with either a rectangular or a round mouthpiece should be able to fit into a spacer — ask your healthcare provider for a demonstration if you are unsure how to set it up. If your child has used an inhaler that contains steroids, make sure they rinse their mouth out with water or brush their teeth to help prevent side effects. Spacers should be replaced every 6 to 12 months. You can distract your baby with music or a video if it helps. If you need to give further doses, wait 30 seconds to one minute, shake the inhaler again, then repeat the steps above. As mentioned previously, some dry powder inhalers can be used by age 4 years, while others are better suited for patients 8 years and older. For hospitals that choose to dispense individual MDIs to patients, all manufacturers should provide smaller “institutional” containers of MDIs to prevent unnecessary costs and waste.” You can check your inhaler technique with your doctor, practice nurse or pharmacist. To help you use a spacer and a mask with your baby, here’s a simple guide: Watch our video for more advice on using a spacer with a facemask on your baby or child. The use of isopropyl alcohol at 70% concentration does seem to be effective in reducing culturable colonization. Abstract. To use your puffer with a spacer: Shake the inhaler well before use (3-4 shakes) Whichever technique you use, if you need to take another dose, take the mask away from your face. Clean the inhaler mouthpiece, and spacer at least once a week. How To Use Inhalers, Spacers: What is a metered dose inhaler (MDI)? Even if you’re finding it difficult using a spacer with your baby, it’s important to keep trying. Speak to your GP or asthma nurse for help. Wash in warm soapy water, rinse and leave to dy naturally, drying with a cloth can cause fibres to stay in the spacer which can then be inhaled. Inhaler device use and reuse is widespread, and there is a wide variation in the methods used to prevent cross-contamination. If it’s a new spacer, clean it before you use it for the first time, then once a month afterwards. I know many health centers and schools will disinfect the peak flow meters for use by different patients. The absence of research or case reports on pathogen transmission and resultant clinical infection should not necessarily lead to the assumption that no risk exists, although evidence of this, even in immunocompromised patients, is scarce. 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