MDI Spacer

A spacer is an open-ended tube or bag that is of adequate volume to accept the contents of an MDI actuation.  This allows for the aerosolized drug to collect in a reservoir that can be inhaled at the user’s pace, obviating the need to coordinate actuation with inhalation.  In order to do so, a spacer should be 100-700 mL in volume and 10-13 cm from MDI nozzle to mouth.9   While the medication disperses in the spacer, there is an evaporation of the propellant, which leads to a decrease in particle size.  Because of this, spacers can elevate the bioavailability of an MDI medication, though dilution can occur if the patient exhales into the spacer prior to inhaling the dose. 

Additionally, spacers slow down the velocity of aerosolized particles before reaching the mouth, thus decreasing oropharyngeal deposition.  Spacers are primarily used for patients who have problems with coordination of actuation and inhalation and are especially recommended for children with respiratory disease younger than 5 or 6.  Spacers do not improve drug delivery in patients with the correct MDI technique.  They may also be used for MDIs containing glucocorticoids to decrease the risk of oral thrush. Spacers are not available OTC and require a prescription for use.  Larger-sized spacers may be more efficacious than their smaller counterparts but may require longer administration times. Beta-agonists administered by MDI with a spacer appears to be as effective as medication delivered by jet nebulizer. The spacer may also lower the incidence of beta-agonist side effects. 

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