Using an Inhaler with a Spacer in Children

Which devices does this guide cover?

This guide covers a pressurised metered-dose inhaler used with a compatible spacer. Other inhalers work differently. Follow the instructions supplied with your child’s specific inhaler and spacer.

Mask or mouthpiece?

• A well-fitting face mask may be needed when a child cannot make a reliable seal around a mouthpiece.
• A mouthpiece may be used when the child can close the lips firmly around it and follow the demonstrated breathing technique.
• The mask must cover the nose and mouth without gaps. If the seal is poor, less medicine may reach the lungs.
• Ask the treating team to confirm when your child is ready to move from a mask to a mouthpiece.

Using the inhaler and spacer

1. Check that the inhaler mouthpiece and spacer are clean, unobstructed, and correctly assembled.
2. Remove the inhaler cap, hold the inhaler upright, and shake it as directed in its instructions.
3. Insert the inhaler firmly into the compatible end of the spacer.
4. Place the mask securely over the nose and mouth, or ask the child to seal the lips around the mouthpiece.
5. Press the inhaler once, then let the child breathe through the spacer as demonstrated for that device.
6. If more than one puff has been prescribed, give each puff separately and repeat the demonstrated sequence.
7. Replace the inhaler cap after use. Follow the child’s individual plan and product instructions for any mouth rinsing or face wiping needed afterward.

Cleaning and checking the spacer

• Follow the manufacturer’s cleaning instructions because devices differ.
• Allow the spacer to air-dry when directed; wiping some plastic spacers may increase static and reduce medicine delivery.
• Check the mask, mouthpiece, valves, and chamber for damage or blockage.
• Replace damaged or poorly functioning equipment after advice from the treating team or supplier.

Common technique problems

• Spraying several puffs into the chamber together instead of giving them separately.
• A loose mask seal or lips not closed around the mouthpiece.
• Pressing the inhaler before the mask or mouthpiece is in position.
• Using an incompatible, blocked, damaged, or incorrectly assembled device.
• Not having technique checked regularly, particularly when symptoms are not well controlled.

When to seek help

Important medicine safety

This page demonstrates device principles only. It does not tell you which medicine to use or how many puffs your child needs. Do not start, stop, substitute, or change inhaled medicines without advice from the clinician responsible for your child.

Medical disclaimer

References

1. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2026.
2. NICE. Asthma: diagnosis, monitoring and chronic asthma management, NG245.
3. Great Ormond Street Hospital for Children. How to help your child use an inhaler.
4. NHS. How and when to use salbutamol inhalers.