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For adults and children over about 5 years who use a press-and-breathe inhaler (a "puffer") with a spacer.

Drawing: An inhaler, a spacer, the inhaler fitted into the spacer, the lungs, and water to rinse the mouth. — An inhaler, a spacer, the inhaler fitted into the spacer, the lungs, and water to rinse the mouth.

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Patient's name Date Preventer inhaler Puffs and times a day Reliever inhaler Puffs when needed

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A spacer puts more medicine into the lungs and less in the mouth and throat. In a mild or moderate attack, an inhaler with a spacer works as well as a nebuliser.

The steps

Sit or stand upright. Take the cap off the inhaler and check the mouthpiece is clear.
Shake the inhaler well.
Fit it into the back of the spacer.
Breathe out gently, away from the spacer.
Put the spacer mouthpiece between your teeth and seal your lips around it.
Press the inhaler once.
Breathe in slowly and deeply over 3 to 5 seconds, then hold your breath for up to 10 seconds. If you cannot do that, take 4 to 5 normal breaths in and out through the spacer.
For the next puff: wait 30 to 60 seconds, shake again, and repeat from step 4.

One puff at a time. Two puffs pressed together into the spacer deliver less medicine, not more.

After a steroid (preventer) inhaler

Rinse your mouth with water, gargle and spit it out. This prevents a sore mouth, white patches in the mouth (thrush) and a hoarse voice.

Common mistakes

Not shaking the inhaler before each puff
Breathing in too fast. Some spacers have a whistle: if it sounds, you are breathing in too fast.
Pressing the inhaler and then waiting before breathing in
Not holding the breath
Using an empty inhaler. Check the dose counter. If there is none, note the date you started and count the doses. Do not float the canister in water.
Stopping the preventer when you feel well

A new inhaler

A new inhaler, or one not used for a week, needs test sprays into the air before use. The number is on the leaflet in the box.

Caring for the spacer

Wash it once a month and after a chest infection. Wash a new plastic spacer before first use.
Take it apart. Wash in warm water with a little dish-washing liquid. Do not scrub the inside.
Let it dry in the air. Do not wipe the inside with a cloth or tissue: wiping makes the medicine stick to the walls.
Whether to rinse off the soap differs between spacers. Follow the leaflet for yours.
Replace it every year, or sooner if it cracks or the valve sticks.

Bring your inhaler and spacer to every visit

Show us how you use them. Most people who are "not improving" on an inhaler have a technique problem that takes two minutes to correct.

Questions about this sheet? Call Caspian Healthcare reception on +91 89193 41154. A doctor is on duty at all hours for problems that are not critical. Caspian has no emergency department: in an emergency call 108.

Where this comes from

Prepared by Caspian Healthcare from the sources above. Last reviewed October 2026. General information: your own doctor's written instructions come first.