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Metered-Dose Inhaler, How to Use with a Collapsible Bag Spacer


A metered-dose inhaler (MDI) is a pressurized canister of medicine that releases a medicated mist. Inhaled asthma medicines contain a gas that helps the medicine get into your lungs. Chlorofluorocarbon (CFC) depletes the ozone layer in our atmosphere. It has been replaced in inhalers by hydrofluoroalkane (HFA). The medicine in HFA inhalers is the same as the medicine in CFC inhalers. It's the gas used to push the medicine out of the inhaler that has changed. The HFA inhaler looks just like a CFC inhaler, but is a little different. The spray comes out with less force, is warmer, and has a slightly different taste. It is not felt as much in the throat when inhaled, but you still get the right amount of medicine.

The spacer is a device that traps medicine and increases the space between the metered-dose inhaler (MDI) and the mouth. This helps your child inhale more medicine into his lungs. It also decreases the amount of medicine deposited on the back of his throat. The use of a spacer is recommended for all MDIs.

InspirEase and EZ Spacer are two brands of the collapsible bag type spacer. EZ Spacer can be used with a mask, but InspirEase cannot.

To attach the spacer to the MDI:

  1. Attach the inhaler mouthpiece to the blue reservoir bag by matching the tabs in the reservoir bag.
  2. Push in, twist, and lock.
  3. Pull the blue reservoir bag all the way open so there are no wrinkles.
  4. Remove the inhaler canister from the plastic case and shake it vigorously.
  5. Attach the canister to the inhaler mouthpiece.

To use the MDI with the spacer and mask:

  1. Select the proper size mask for your child (small, medium, or large) and attach to the mouthpiece end.
  2. Have your child stand or sit up straight.
  3. Put the mask to your child's face, covering both the nose and mouth. The mask must be pressed to your child's face to make sure that the medicine can get to the child's lungs.
  4. Depress the MDI once. The medicine will be trapped in the reservoir bag.
  5. Have your child breathe in slowly over 3 to 5 seconds. (The reservoir will collapse as your child inhales. A whistling noise will sound if the breath is too fast.)
  6. Have your child hold his breath for 5 to 10 seconds.
  7. Have your child breathe out slowly back into the reservoir bag.
  8. Still using the bag, have your child breathe in and out slowly once or twice more.

To use the MDI with the spacer and mouthpiece:

  1. Put the mouthpiece between the teeth and seal the lips around it.
  2. Depress the metered-dose inhaler. The medicine will be trapped in the reservoir bag.
  3. Breathe in slowly over 3 to 5 seconds. (The reservoir will collapse as you inhale. A whistling noise will sound if the breath is too fast.)
  4. Hold your breath for 5 to 10 seconds.
  5. Breathe out slowly back into the reservoir bag.
  6. Still using the bag, breathe in and out slowly once or twice more.
  7. If you are taking an inhaled steroid medicine, rinse your mouth and spit out the water after the last dose.

Cleaning the equipment

The mouthpiece should be washed daily with warm water and dried. (Do not put it in the dishwasher.) The manufacturer does not recommend washing the reservoir bag. The bag should be replaced when it wears out, or once every month.


Written by the Asthma Task Force at The Children's Hospital, Denver.
Published by RelayHealth.
Last modified: 2011-02-04
Last reviewed: 2010-12-13

This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a health care professional.

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