What is a spacer or valved holding chamber?


Both spacers and valved holding chambers were designed as accessories to be used with your inhaler, puffer or pMDI to help deliver medication to your lungs where it is needed.

    A valved holding chamber is a spacer which helps deliver more medication to your lungs where it is needed.


    A spacer is a generic term used to describe a tube-like accessory that extends the mouthpiece of the inhaler and directs the medication towards your mouth.  A valved holding chamber is a spacer which contains valves to hold the aerosol for a short time.  The valves open to release the medication when you breathe in.

    These devices  can be especially helpful in young children and in patients of any age who are prescribed an inhaled corticosteroid which may also be called a steroid.

    Why is it important to use a spacer or valved holding chamber with your inhaler?


    Helps reduce the risk of inhaler side effects1, 2, 3, 4, 5, 6, 7.
    Aerosol medicine comes out of the inhaler very quickly so it is often very difficult to use an inhaler correctly because the canister needs to be pressed at the same time as you breathe in8, 9.

    Enhances your treatment. Medicine often ends up in your mouth, throat and stomach when using an inhaler on its own. A valved holding chamber may improve drug delivery to the lungs where it is needed by as much as up to 4 times10.

    Should a facemask or a mouthpiece be used?


    Babies and all young children, who cannot use the mouthpiece of the chamber, should be encouraged to use a facemask11, 12. It is important that the facemask fits comfortably on the face, providing a good fit, to help them receive the proper dose of inhaler medication.
     

    To use the mouthpiece effectively your child needs to be able to firmly close their teeth and lips around the mouthpiece so they can take a slow deep breath and hold the breath for a few seconds. Children who cannot do this, will need to use a facemask.

    Many valved holding chambers have the following additional unique benefits over a spacer:

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    One way valve stops you accidentally exhaling into the chamber13 and lets you breathe easily14
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    Anti-static materials that suspend the aerosol for longer, meaning you have more time to inhale your medication15
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    A flow alert “whistle” lets you know if you are breathing in too quickly

    The benefits of a spacer or valved holding chamber
     

    Inhaler only
    Inhaler only
    Medicine end up in the mouth, throat and stomach which may cause side effects.
    Inhaler with chamber
    Inhaler with spacer
    More medicine is delivered to the lungs where it can be most effective.

    The benefits of using a mask with a spacer or valved holding chamber for children with asthma

    Mask with a poor seal
    Mask with a poor seal
    Inhaling with a poorly fitted facemask means that most of the medicine will be lost and not delivered to the lungs17.
    Mask with a proper seal
    Mask with an effective seal
    Inhaling through a mask that provides a soft but effective seal can help to maximize delivery of medication to the lungs17.

    Philips OptiChamber Diamond – valved holding chamber

    pharmacy preffered brand
    #1 Pharmacy preferred brand of spacer among retail pharmacies18.
    Philips’ OptiChamber Diamond Valved Holding Chamber is discreet, portable and small enough to carry with you in your handbag or in your child’s school bag.  It is designed to improve aerosol delivery to the lungs and can help you maximize the effectiveness of your child’s inhaled therapies.
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    Philips valved holding chamber - OptiChamber Diamond

    Tips on use and care for your OptiChamber Diamond

    how to use with a litetouch mask
    How to use with a LiteTouch Mask
    how to use with a mdi inhaler
    How to use with an MDI inhaler
     
    how to clean chamber
    Cleaning the chamber
    how to clean chamber and mask
    Cleaning the chamber and mask

    Other products for asthma treatment

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    DISCLAIMER:
    Information on this website is informational only and should not replace the advice of a physician.

    FOOTNOTES:
    [1] Salzman G., Pyszynski D. Oropharyngeal candidiasis in patients treated with beclomethasone dipropionate delivered by metered-dose inhaler along and with Aerochamber. Journal of Allergy and Clinical Immunology, 1988; Volume 81, Issue 2: 424-428.

    [2] Derendorf H., Nave R., Drollmann A., Cerasoli F., Wurst W. Relevance of pharmacokinetics and pharmacodynamics of inhaled corticosteroids to asthma. European Respiratory Journal, 2006; 28:1042-1050. 

    [3] Roller M., Zhang G., Troedson R.G., Leach C.L., Le Souëf P.N., Devadason S.G. Spacer inhaler technique and deposition  of extra fine aerosol in asthmatic children. European Respiratory Journal, 2007; 29:299-306. 

    [4] Von Hollen D., Slater L., Hatley RHM. Impact of flow rate on NGI throat deposition from 3 HFA Inhaler formulations with anti-static valved holding chambers. Journal of Aerosol Medicine and Pulmonary Drug Delivery, 2013; 26(2); A45-A46.

    [5] Oliveira R.F., et al. VHC performance evaluation at constant flow: 30L/min. Proceedings of the ASME2015 International Mechanical Engineering Congress and Exposition, 2015 Houston Texas.

    [6] Leach C., Colice G. A Pilot Study to Assess Lung Deposition of HFA-Beclomethasone and CFC-Beclomethasone from a pressurized Metered Dose Inhaler with and without add-on spacers and using varying breath hold times.  Journal of Aerosol Medicine and Pulmonary Drug Delivery, 2010; 23(6):355-361.

    [7] Dickens G., et al. Pharmacokinetics of flunisolide administered via metered dose inhaler with and without a spacer device and following oral administration. Annals of Allergy, Asthma & Immunology, 2000; Volume 84, 528-532. 

    [8] Saunders K.B.  Misuse of inhaled bronchodilator agents.  Br Med J. 1965; 1:1037-1038. 

    [9] Oprehek J., et al. Patient error in use of bronchodilator metered aerosols. Br Med J. 1976; 1:76.  

    [10] Gardenhire D., Arzu A., Dean H., Myers T. A guide to aerosol delivery devices for respiratory therapists 3rd edition, American Association for Respiratory Care, 2013. 

    [11] Nhlbi.nih.gov. Delivery devices in infants and young children. Accessed September 2017. 

    [12] Hsu W., et al. Evaluation of delivery efficiency from valved holding chambers with facemasks. Resp. Drug Delivery Europe, 2011; 2:505-510.  

    [13] Lung.org. Managing asthma/Valved holding chambers. Accessed September 2017. 

    [14] Everard ML., Clark AR., Milner AD. Drug delivery from holding chamber with facemask. Arch Dis Child, 1992; 67:580-585.

    [15] Mitchell J. et al. Electrostatic and inhaled medications: Influence on delivery via pressurized metered dose inhalers and add on devices. Respiratory Care, 2000. Volume 52(3):283-300.   

    [16] Adapted from: Hirst, PH., et al. Deposition and pharmacokinetics of an HFA formulation of Triamcinolone Acetonide delivered by pressurized metered dose inhaler. Journal of Aerosol Medicine. 2001; Volume 14 (2):155-166.  

    [17] Adapted from Erzinger, S. et al. Facemaks and aerosol delivery in vivo.  Journal Aerosol Medicine  2007; 20 (Suppl 1):S78-S84

    [18] Among retail pharmacies who claim to have a preferred brand of spacer in their pharmacy. Online survey conducted on 205 registered retail pharmacists.