spacer woes! How to get the optimum dose through them?

[Gingercat77]

firstly I should say that I get a sore throat REALLY easily and in the past using my spacer for a full month has led to some horrible throat infections.

So I decided to keep it clean and I was working a system of two spacers, washing one, using the clean one for a week, then washing the reserve one and using it.

This was all going great and the spacers were both doing their job, when I was switching seamlessly from an old “dirty” one to a new one.

I had noticed that after washing, there was always a build up of white powder inside the mouthpiece which I rinsed with a soft toothbrush.

knowing the horrors of static, I never used a paper towel to wipe any part of the spacer.

the drill was fill the basin with luke warm water and a squirt of washing up liquid, leave to soak for 15 minutes then rinse gently and leave to air dry on a piece of kitchen roll.

however I started using a new “clean” spacer on Friday night and by Saturday afternoon, it was clear that little or no medication had reached my lungs. I had that tight chest and slightly panicky feeling.

so, fearing that the spacer ( and possibly the other one too) had become clogged ( the tube was no longer clear in each, looked a bit clouded) I got my husband to rush down to the pharmacy to buy me a new spacer which I washed before use as above.

I used it when it was dry and felt relief…issue solved I though …but…the next night I had the worst sweats and couldn’t sleep at all…the morning after… a tight chest…😩

I’m imagining that I haven’t been receiving the same optimum dose with the brand new spacer.

I don’t know whether to go back to old spacer no2 or soldier on with new spacer, hoping that the delivered dose will feel more effective as the spacer gets used.

Anyone know what I’m doing wrong? Normally I’m really well controlled…2 puffs of clenil modulate 200 morning and evening…using aerospace spacer with normal mouth port.

Our GP surgery said this morning they were not seeing any patients today so I went to casualty, which was only useful in ruling out any infection ( x ray and bloods done)

No advice re spacers, meds or technique could be given.

I have heard that people dip their spacers into soapy water before using but how can germs be effectively be washed away & does it taste soapy?

any advice from experience really appreciated.

Sorry for the long post, many thanks

[Patk1]

I wash mine in soapy water and use a baby's bottle brush then use half a boots sterilising tablets in empty tub( of icream) to sterilise.ive been using mine for prob 12-14YEARS.Itmayve been Yr asthma being " off"

[Gingercat77 in reply to Patk1]

thanks so much for your reply. The brush idea sounds good but I really fear creating static!

[rmros in reply to Patk1]

Sorry, you've been using the same spacer for 12-14 years?!

[Patk1 in reply to rmros]

Yes,but that said I do have 4 on the go xx

[rmros in reply to Patk1]

That's impressive! I was told I should change mine every 2 years but I think they assume people don't clean them often enough or properly. I don't like waste, especially when it's plastic, so I'd be interested to know how long they really last if looked after.

[peege in reply to rmros]

I was told on PR to get a new one every six months. Needless to say, this doesn't happen. In over 8 years I've only managed to get one from the surgery 🙄

Gingercat77, are you sure it's the spacer? My Fostair inhalers frequently stop spraying into the spacer & regularly stop with 70 - 80 inhalations left. Occasionally I can get them going again but cleaning the dimple with a samp cotton bud

[Gingercat77 in reply to peege]

Hi peege thanks for your reply. Yes this often happens with the clenil brown inhalers but you can always tell because the sound of the spray is different. Luckily our surgery always prescribes two items so I have a backup when this happens.

Pretty sure it’s the spacer.

[Blue-Breeze]

Hello. I use an Aerochamber plus Flow-Vu. First given to me in hospital and surgery replaces, which I do yearly. I have a back up Aerochamber whilst in wash.I wash mine in soapy water, clean areas with baby bottle brush. Rinse then leave in Milton for short while. Rinse and leave to dry naturally.

As for inhaler not working. I often remove mine from spacer, just to check there is no residual build up.

Asthma UK nurses are a wealth of knowledge too. You could call them for advice.

[Gingercat77 in reply to Blue-Breeze]

Thanks for your reply… does using a bottle brush not cause static?

[Blue-Breeze in reply to Gingercat77]

I have not found this to be the case, yet anyway. Mine has a sponge on one end and a tiny brush the other. I'm not going in for the all out scrubbing either. Hope that helps.

[fraid]

I also noticed how much residue is left in spacer which should be in my lungs! Although I wash it per instructions, soapy water, don't rinse, it was still white so I do dry it with paper towel to get it shiny so I know it's clean. What static? Have been wondering if it would be better to not use, so Flixotide gets in me not spacer? 🤔

[Gingercat77 in reply to fraid]

Someone please correct me but if this is wrong but my GP told me to never use a paper towel inside the mouthpiece or tube of a plastic spacer as it causes static, meaning the medicine will stick to the inside of the spacer and not flow into to your lungs. I was told to always air dry instead.

[Lysistrata Administrator Community Ambassador in reply to Gingercat77]

fraid and Gingercat77 - yes I was told this too, don't dry with a cloth as it can cause static, always air dry. From the link below:

asthmaandlung.org.uk/sympto...

Take your spacer apart and gently clean it with warm water and a detergent, such as washing-up liquid.

Only a small number of brands of spacer are dishwasher safe, so check the instructions on the label.

Use warm water instead of boiling water, as boiling water may damage the spacer.

Be careful not to scrub the inside of your spacer as this might affect the way it works.

Leave it to air-dry as this helps to reduce static (an electrical charge that builds up) and prevent the medicine sticking to the inside of the spacer.

When it’s completely dry, put your spacer back together ready for use.

Wipe the mouthpiece or mask clean before you use it again.

[fraid in reply to Gingercat77]

In my case so much was sticking to the tube long before I wiped it, now less so but I still wonder how much is wasted. 🤔

[Gingercat77 in reply to fraid]

Many are saying to leave the spacer to soak for 15 minutes in warm soapy water, do not rinse, leave to air dry. It’s the do not rinse part I can’t get my head round 😊

I suppose it’s unavoidable that some residue will be left in the tube, mine goes cloudy after a few weeks usage, not sure if this is build up of medication or propellant or soap.

Some people use a soft bottle brush to remove this, but use it very very gently or it might cause static.

To be honest I’m just really confused about what’s the best practice!

[fraid in reply to Gingercat77]

Yes I did all that for a long time but it did taste a bit soapy plus still left residue, so I rinsed, wiped and less build up, but like I say-some still left in tube that should be in my lungs? Shall try without spacer and let you know. 🤔

[Gingercat77 in reply to fraid]

they do recommend using a spacer. It’s hard to get the full dose without it…but I’ve just read that Aerochamber are now doing anti static spacers… I’m going to ask for one when I see the asthma nurse to see if they help. Might be worth checking out!

[fraid in reply to Gingercat77]

I know spacer is recommended but if some of the dose is left in it, surely you're getting it all? 🤔 Does static really make much difference, if so then not using spacer would be more efficient? 🤔

[fraid in reply to fraid]

Meant NOT getting it all...

[Gingercat77 in reply to fraid]

I think the issue with not using it is, that most of it ends up in your mouth and throat rather than lungs.

[Lysistrata Administrator Community Ambassador in reply to fraid]

You're not getting it all in with or without a spacer, realistically. You just get *more* with a spacer than without (can't remember the exact percentages but it's definitely quite a bit more that gets in with the spacer, just still nowhere near 100%). Spacers also help the dose go to the right place ie the lungs/airways, not the mouth and throat, which is why they help reduce side effects in those areas.

I assume it's just much easier to see the part you don't get with a spacer because it's captured in the device, vs going into the air or your mouth.

[fraid in reply to Lysistrata]

Thanks but still don't see the difference- it's not like it has a tube or fan going directly into your lungs, it has further to travel so more surely gets lost on the way? Only reason I started spacer is coz I can't hold my breath for recc. 30 secs. It still depends on how deep you breathe it in. Hmm, conundrum... 🤔

[Lysistrata Administrator Community Ambassador in reply to fraid]

I wasn't sure of the details so looked it up. Having a delay actually helps:

Aside from removing the problem of co-ordinating activation of pMDIs with inhalation, the use of a spacer augments the time between expulsion of the aerosolised particles from the device and their inhalation. This serves two particular functions. First, it facilitates evaporation of the particles to a size capable of penetrating through the entire bronchial tree as far as the alveoli (i.e., with mass median diameter less than ~5 microns: particles emitted directly from a pMDI device are initially much larger). Second, it facilitates slow inhalation of the evaporated particles into the lungs, which is essential if they are to negotiate beyond the right-angle bend between horizontal emission from the spacer device and the vertical passage through the larynx. It has been shown that several varieties of commercially available spacer devices increase the proportion of particles emitted from a typical HFA-propelled pMDI device.

From this paper on inhaler myths, if anyone wants to read it all: nature.com/articles/npjpcrm...

This paper on spacers may be interesting too: ncbi.nlm.nih.gov/pmc/articl...

[fraid in reply to Lysistrata]

Thanks for that, can only believe what we're told. Maybe time they developed a nasal one so it goes straight into lungs? Seems so wasteful plus side effects of thrush etc. 🧐

[Shogi in reply to fraid]

I started using the AeroChamber Plus with the face mask, rather than the mouthpiece. The soft mask part is easily removable for cleaning. This allows you to nasal breath your inhalers, as well as tidal breathe more easily, at times when breathing is hard anyway. Still always best to rinse or gargle after though. I find this my best method.

GP can prescribe, or you can buy yourself online from Amazon, online pharmacies, etc. They can come with an adult or child size mask, and I am going to ask for a child size next time, as I find the adult mask slightly too big to get a good seal on my smallish face.

Hope this helps.

[fraid in reply to Shogi]

Thanks but don't like things covering my face, a sort of claustrophobia! I was thinking more of one you can sniff up your snoot. 😁 Tried Flixotide without spacer not sure was as good so shall go back to using it.😕

[Lysistrata Administrator Community Ambassador]

Hi, I'm wondering if you've tried a dry powder inhaler to remove issues with spacers? Of course, this may not be suitable if you find you get a sore throat easily - they don't work for everyone!

It would probably be worth a chat with the ALUK nurses about your medication/spacers, as you were hoping for advice from A&E on this (some A&Es are trying to bring in asthma nurses when someone attends with asthma, but it's definitely not universal). They may recommend seeing your GP or asthma nurse to chat through what would work best, but can advise on your options/what to discuss with the GP or nurse. 0300 2225800 or WhatsApp on 07999 377 775 Monday-Friday 0915-5pm

I imagine you already know this so feel free to ignore if there's nothing new. but this is the ALUK page on spacers in case it's useful: asthmaandlung.org.uk/sympto...

[Gingercat77 in reply to Lysistrata]

Thank you, I have managed to get an appointment with my asthma nurse for ten days from now. I am going to bring my spacers and ask her about them.

[Mandevilla]

The instructions that came with my spacer said never to rinse or dry it - wash in soapy water and air dry as the soap residue helps prevent the medication from 'sticking' to the spacer. So if you're rinsing the soap off, that might be the problem?

[Gingercat77 in reply to Mandevilla]

Thanks Mandevilla…I have heard that too, but wondered…how do you rinse off the germs in the tube? Would there not be an accumulation of medication and soap in the tube eventually? How would you really get it clean? Does it taste soapy when you inhale? Many thanks

[Mandevilla in reply to Gingercat77]

I'm guessing the soapy water deals with the germs, and you can wipe the outside of the spacer mouthpiece to get rid of any soapy residue. If you're extra worried about germs, I guess you could sterilise the spacer before rinsing it in soapy water?

[Gingercat77 in reply to Mandevilla]

Thanks, yes I’ve had some really nasty throat infections in the past, I used to only wash the spacer once a month but decided it not to risk leaving it so long now. Bacteria in the tube will be something I really need to avoid. If rinsing isn’t advisable maybe pre sterilisation might be the answer. I need to check if you can use sterilising tablets with an Aerochamber. I’ve had asthma for 15 years now. Unbelievable that im still struggling to work out spacers 😹

[Blue-Breeze in reply to Gingercat77]

I tried the not rinsing, but to be honest I didn't like the taste. I am sensitive to most things though. So went to rinse and air dry. My asthma nurse at the hospital has said mine can go in the dishwasher, not don't that.

[Shogi]

See my reply to one of Fraid’s replies.

Using the “AeroChamber Plus with Mask” rather than mouthpiece, means you can nasal breathe, and avoid medications hitting the back of your throat. See if your Asthma Nurse has one to show you. Good luck with your appointment, and thanks for your post, as I’ve learned a few things from it 👍