Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

Chambers/ Spacers

Holding chambers are devices with one-way valves that hold the medication for a few seconds after it has been released from the inhaler. This allows the client the advantage of taking more than one breath in for each puff when unable to hold their breath, particularly in an acute episode. The client must remember to wait a minute between each puff of the inhaler, even when using a holding chamber. This ensures the patient is receiving the prescribed amount of medication. Holding chambers are indicated for all individuals who:

  • use a Metered Dose Inhaler
  • have trouble coordinating the hand-breath step

When a holding chamber and inhaler are used, the larger particles drop down into the holding chamber. This limits the amount of particles in the mouth and throat, which in turn limits the amount absorbed systemically. Using a holding chamber may prevent a hoarse voice or sore throat which can occur with inhaled steroid use. Whether a holding chamber is used or not, individuals using inhaled steroids should gargle after treatment.

Proper Use of a Holding Chamber with Mask:

  1. Remove the cap from the mouthpiece and shake the inhaler.
  2. Place the MDI upright in the holding chamber’s back rubber opening.
  3. Place the mask over the nose and mouth to make a firm seal. The valve on the mask will move with each breath taken.
  4. Press down on the canister, releasing one puff of medication.
  5. Hold the mask in place until six breaths are taken. If able, slow deep breaths taken through the mouth as this is the most effective.
  6. If a second puff is required, wait 60 seconds and repeat steps 3-5.

Proper Use of a Holding Chamber:

  1. Remove the cap on the inhaler (MDI) and holding chamber mouthpiece.
  2. Shake the inhaler well immediately before each use. Insert the inhaler (MDI) into the back rubber opening on the chamber.
  3. Put mouthpiece into mouth.
  4. Depress inhaler (MDI) at beginning of slow deep inhalation. Hold breath as long as possible, up to 10 seconds before breathing out. If this is difficult, an alternative technique is to keep mouth tight on mouthpiece and breathe slowly 2-3 times after depressing inhaler (MDI).
  5. Administer one puff at a time.
  6. Slow down inhalation if "whistling" sound is heard.
  7. Follow instructions supplied with the inhaler (MDI) on amount of time to wait before repeating steps 3 – 6, as prescribed.
  8. Remove the inhaler and replace the protective caps after use.

Care of a Holding Chamber (with/without mask)

  • Whichever holding chamber is used, it must be cleaned at least once a week with warm soapy water, rinsed with clean water, and air dried in a vertical position.