How to use a metered dose inhaler (puffer) with a spacer for adults

This instructional video consists of two parts:

• How to use a metered dose inhaler with an AeroChamber spacer.
• How to use a metered dose inhaler with an AeroChamber spacer and a mask.

How to use a metered dose inhaler with an AeroChamber spacer

A metered dose inhaler provides a puff of medication to the lungs, in a measured dose. It consists of a plastic casing which contains a small metal canister. The casing has a mouthpiece that is covered by a cap.

Some metered dose inhalers have a dose counter, showing how many doses of medication is left. Each time the canister is pressed, one puff of the medication is released and the counter will count down in increments.

By using a spacer with the metered dose inhaler, the medication is better delivered down into the small airways, where it is most needed. Otherwise, without a spacer, the medication will remain in the mouth and the back of the throat.

The spacer holds the medication so that you can take as many breaths as needed, to inhale it. It takes away the need to coordinate between inhalation and actuation of the inhaler.

It’s important that people use asthma devices correctly, so that the right amount of medication is delivered into the lungs and patients can get the most benefit from it.

Checklist of steps

1. Before using the inhaler, always check the dose counter and the expiry date – never use the medication after this date.
2. Remove the caps from the inhaler and mouthpiece chamber.
3. Hold the inhaler upright and shake well. Note: not all metered dose inhalers need to be shaken, so please read the instructions for your particular device.
4. If this is the first time you are using your inhaler, or if you haven’t used it in a while, you will need to prime it before placing it into the spacer. Shake well and press down on the canister to release two “puffs” of medication. Note: some medications require 4 puffs to prime – please read the instructions for your particular device.
5. Insert the inhaler upright into spacer.
6. Put the mouthpiece between your teeth without biting down and close lips to form good seal.
7. Keep the spacer horizontal and breathe out gently, into the spacer. Press down firmly on the puffer once.
8. It is important to only use one puff in the spacer at any time – it is a common error to put multiple puffs in at once.
9. Breathe in and out normally through the spacer for 4 breaths. Alternatively, you can inhale slowly and deeply over 3 to 5 seconds until a full breath has been taken. Hold your breath for 5 to 10 seconds before exhaling.
10. Slow down inhalation if you hear a whistle sound, it means you are inhaling too quickly.
11. If someone is helping you, they can use the Flow-Vu inhalation indicator to ensure a good seal, coordinate pressing the inhaler with inhalation and to count the number of breaths taken. The Flow-Vu indicator moves toward you as you inhale and only moves if you have a proper seal.
12. If more than one dose is needed, repeat all steps.
13. Remove the inhaler from the spacer.
14. Replace the mouthpiece cover on the inhaler and spacer.
15. If using a corticosteroid inhaler, remember to rinse your mouth.
16. The spacer should be cleaned weekly and should be replaced after 12 months of use.

How to use a metered dose inhaler with an AeroChamber spacer and mask

A mask should be used with a spacer when administering inhaler medication to children under 3 years or to individuals who have difficulty coordinating breaths. Babies and toddlers may not be able to close their lips around the mouthpiece of a spacer or inhale correctly. Some adults or children may find it challenging to synchronise the press of the inhaler with taking a deep breath or may not be able to maintain a tight seal with the spacer mouthpiece. 

Checklist of steps 

The initial steps and cleaning instructions are the same as the previous demonstration. 

1. Place the face mask over your nose and mouth, ensuring a good seal around the edges, with no gaps between the mask and the skin. 
2. Put the mouthpiece between your teeth without biting down and close lips to form good seal. 
3. Keep the spacer horizontal and breathe out gently, into the spacer. Press down firmly on the puffer once. Hold the mask in place and breathe in and out normally for 4 breaths. Do not remove the mask from your face between breaths.  
4. Slow down inhalation if you hear a whistle sound, it means you are inhaling too quickly. 
5. If someone is helping you, they can use the Flow-Vu inhalation indicator to ensure a good seal, coordinate pressing the inhaler with inhalation and to count the number of breaths taken. The Flow-Vu indicator moves toward you as you inhale and only moves if you have a proper seal. 
6. If more than one dose is needed, repeat all steps.  
7. Remove the inhaler from the spacer. 
8. Replace the mouthpiece cover on the inhaler and spacer. 

Acknowledgement    

Thank you to Sherri Barden, community pharmacist and asthma educator, and the patients who participated in this video.  

Produced independently by the National Asthma Council Australia 2025 with support by Trudell Medical International.

Disclaimer    

Although all care has been taken, this video is a general guide only, which is not a substitute for assessment of appropriate courses of treatment on a case-by-case basis. The National Asthma Council Australia expressly disclaims all responsibility (including for negligence) for any loss, damage or personal injury resulting from reliance on the information contained herein.