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How to take a puffer and why you need a spacer

Posted by Brigitte Eastwood on 21 November 2013 | 0 Comments Tags: , , ,

How to take a “puffer”, turbuhaler and handihaler

Thanks to the Respiratory Department at Counties Manukau Health I am able to include (see below) the patient handouts on how to use a “puffer” with spacer, a turbuhaler and a handihaler (Spiriva).  These are the most common types of inhalers.  There is also an accuhaler which is less common that I am more than happy to send out on request.

Why do you need a spacer?

At Counties Manukau Health we recommend that all “puffers” are taken through a spacer. 

I know what some of you might be thinking! They seem pretty uncool and can be bulky and obvious, but they really are the only way to ensure you are taking your inhaler correctly every time.

Common mistakes if not using a spacer

  • You push the button to release the medication at the wrong time - either before or after you have breathed in.
  • You open your mouth a little at the wrong time or do not close your mouth enough and end up with some of you medication in the air around you.
  • You are too breathless to breath in enough and at the right time.
  • You end up with a large proportion of the medication in your mouth not all the way into you lungs.

Try this wee test out

Hold you inhaler in one hand, wet the other hand and hold that hand up about 15cm from the inhaler, palm facing the opening of the inhaler. Push the button and spray the medication onto your wet hand. Where does the medication end up? Stuck to your hand! Just like the medication getting stuck in your mouth and not all the way down to the small airways in you lungs.

The benefits of using a spacer

  • More medication into your lungs!₁
  • Therefore less in your mouth and less risk of possible side effects of a hoarse voice or thrush.
  • Reduce the need for excellent timing and hand/ breath coordination.

Patient handouts

Videos on how to use the different inhalers


Very occasionally you may be given a nebuliser. This is becoming more unusual now as research has shown us that the same amount of medication (or even more) can be administered into the lungs through a spacer and puffer/MDI inhaler.₂

More information: how physiotherapy can help with asthma.

This blog was written in conjunction with Michelle Mills, Clinical Nurse Manager and Euna Hwang, Clinical Pharmacist, Respiratory Department, Counties Manukau Health.

₁Bisgaard, H. (1997). Delivery of inhaled medication to children. Journal of Asthma. 34 (6),443-469.

₂Newman, K. Milne, S., Hamilton, C. & Hall, K. (2002). A comparison of albuterol administered by metered dose inhalers and spacer with albuterol by nebulizer in adults presenting to an urban emergency department with acute asthma, Chest; 121, 1036-1041.

Brigitte EastwoodBrigitte Eastwood has worked at Counties Manukau Health since she graduated in 2006 from Otago. She has a postgraduate certificate in paediatrics from Melbourne University. She is a senior physiotherapist in the cardiorespiratory team and currently covers pulmonary and cardiac rehabilitation, helps out on the wards, works weekends/oncall, is currently involved in two respiratory physiotherapy research projects and runs a paediatric respiratory clinic. Brigitte has also spent four months volunteering in Nepal as a physiotherapist a few years ago and has assisted with Respiratory clinics in Samoa.

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