When a child with asthma has a flare-up, every second counts. But giving them a puff from an inhaler isn’t always enough. Many parents and teachers don’t realize that without a spacer, most of the medicine never reaches the lungs. Instead, it sticks to the mouth and throat, wasting the dose and increasing side effects like hoarseness or thrush. The truth? Spacers aren’t optional accessories-they’re essential tools that turn a shaky, ineffective treatment into something reliable, safe, and life-changing for kids.
Why Spacers Are Non-Negotiable for Kids
Children under five can’t coordinate pressing an inhaler and breathing in at the same time. Even older kids often mess up the timing. That’s where spacers come in. These plastic tubes, usually 10 to 20 centimeters long, hold the medicine after you press the inhaler. The child then breathes in slowly through their mouth (or nose, if using a mask) over four slow breaths. No perfect timing needed.
Studies show that when used correctly, spacers deliver 73% more medication to the lungs than inhalers alone. In one major study, kids using spacers had a 58% lower chance of being admitted to the hospital during an asthma attack compared to those using nebulizers. And it’s not just about saving trips to the ER-spacers cut costs, too. A single nebulizer treatment can cost $100 or more in the ER. An inhaler with a spacer? Less than $5 in medicine and a one-time $20 device.
Guidelines from the Global Initiative for Asthma (GINA) and the American Academy of Pediatrics say the same thing: for every child under 12, use an inhaler with a spacer. Not a nebulizer. Not alone. Always with a spacer. And it’s not just for emergencies. Kids on daily controller meds like fluticasone need spacers too, to get the full benefit and avoid hoarseness or yeast infections.
How to Use a Spacer Correctly (Step by Step)
It sounds simple, but most families get it wrong. Here’s what actually works:
- Have your child sit up straight-no lying down or slouching.
- Attach the spacer to the inhaler. Make sure the mask or mouthpiece fits snugly.
- Shake the inhaler well.
- Press the inhaler once to release one puff into the spacer.
- Have your child breathe in and out slowly through their mouth (or nose with a mask) four times. Count to five on each breath.
- Wait 30 seconds before giving a second puff, if prescribed.
- Wash the spacer once a week with warm water and a drop of dish soap. Don’t rinse it-just let it air dry. Rinsing creates static that traps medicine.
- Never wipe the inside dry with a towel. Static builds up and steals the dose.
- If the spacer gets wet from moisture or condensation, use the inhaler without it until it’s dry.
Parents often think, “My kid used it once, they know how.” But technique slips. A 2022 study found that kids aged 8 and under got it right 88% of the time with a mask. By age 14? Only 20% did it correctly. That’s why schools need regular check-ins.
Why Schools Are Critical for Asthma Control
One in 12 U.S. children has asthma. That’s 6.2 million kids. And they spend six to seven hours a day at school. If their inhaler isn’t accessible, or if staff don’t know how to help, a simple cough can turn into an emergency.
The National Asthma Education and Prevention Program says every student with asthma should have an individualized asthma action plan. That means written instructions on what meds to use, when, and who to call. But only 42 states require schools to keep asthma meds on-site. And even then, many schools don’t stock spacers.
Here’s what works in the best-run schools:
- A designated staff member (usually the school nurse) is trained to help with spacer use.
- Spacers are stored in a cool, dry place-not in a hot car or a dusty closet.
- Teachers get a 15-minute refresher every six months on how to recognize early signs of an attack and how to help with the spacer.
- Parents and the school nurse share the asthma action plan, updated every 6 to 12 months.
One 2022 study found schools with full asthma policies saw 37% fewer asthma-related absences. That’s not just better attendance-it’s better grades, less stress for parents, and fewer missed workdays.
Common Problems and How to Fix Them
Spacers are simple, but they’re not foolproof. Here are the top three issues families and schools face-and how to solve them:
Problem 1: “My child refuses to use it at school.”
Teens hate standing out. A bulky spacer feels like a medical device they don’t want to carry. Solution: Use a compact, quiet spacer like the AeroChamber Plus or Volumatic. Some even come in fun colors. Talk to your child about how it helps them stay in class, play sports, and avoid the ER. Let them pick the color.
Problem 2: “The spacer doesn’t seem to work.”
If the child coughs right after using it, or if you see white flakes on their tongue, the medicine isn’t getting deep enough. Most likely, the spacer is wet or staticky. Wash it weekly with soap, don’t rinse, and let it air dry. Keep a spare spacer at school-just in case.
Problem 3: “We don’t have one at school.”
Many schools don’t stock spacers because they’re not required to. But federal guidelines say schools must allow students to carry and use their own asthma meds. If your child’s school doesn’t have one, request a copy of the school’s asthma policy. Ask if they can keep a spare spacer in the nurse’s office. If they say no, contact your local chapter of the American Lung Association-they can help you advocate for change.
What’s Changing in 2025
The CDC’s 2023-2025 National Asthma Control Program is now funding spacer distribution in rural and low-income schools where access is poorest. New research is testing smartphone apps that use the phone’s camera to check if a child is using the spacer correctly. One NIH-funded study is tracking 500 kids across 20 schools, using AI to analyze video of inhaler use and give real-time feedback. Early results show kids who got feedback improved their technique by 60% in just three months.
Spacers are also getting smarter. New models have built-in counters that track how many doses have been used, and some even light up when the child breathes in correctly. These aren’t toys-they’re tools designed to make compliance easier for kids who forget, or feel embarrassed.
What Parents and Teachers Need to Do Now
You don’t need to be a doctor to help a child with asthma. Here’s your checklist:
- Make sure your child has a spacer and knows how to use it. Practice every week.
- Keep a spare spacer at school, labeled with their name.
- Give the school a signed asthma action plan from their doctor.
- Ask if the school nurse is trained in spacer use-and if not, offer to bring in a free training from the American Lung Association.
- Check the spacer every month: Is it cracked? Is it clean? Is it dry?
Every child deserves to breathe easily-not just at home, but in the classroom, on the playground, and during gym class. Spacers make that possible. But only if they’re used right, kept ready, and supported by the people around the child.
Do all children with asthma need a spacer?
Yes. Every child using a metered-dose inhaler (MDI) should use a spacer, regardless of age. Even toddlers benefit because spacers eliminate the need for perfect timing. The American Academy of Pediatrics and GINA guidelines recommend spacers for all children under 12, and many experts extend that recommendation to teens. Without a spacer, up to 80% of the medicine stays in the mouth and throat, reducing effectiveness and increasing side effects.
Can a child use an inhaler without a spacer?
Only in emergencies, and only if no spacer is available. If a spacer is wet, broken, or missing, using the inhaler alone is better than doing nothing. But it’s far less effective. Studies show that without a spacer, children get less than 30% of the intended dose into their lungs. For daily controller medications, skipping the spacer can lead to worsening symptoms over time. Always replace a damaged spacer right away.
How often should a spacer be cleaned?
Clean the spacer once a week with warm water and a drop of dish soap. Do not rinse it after washing. Just shake off excess water and let it air dry completely. Rinsing creates static electricity, which traps the medicine inside the spacer. Never wipe the inside with a towel or paper towel-this also creates static. If the spacer looks dusty or feels sticky, clean it immediately. Keep a second spacer on hand for school or travel.
Why do some schools not have spacers available?
Many schools don’t stock spacers because state laws vary. Only 42 states require schools to keep asthma medication on-site, and even fewer require spacers specifically. Budget limits, lack of training, and misunderstanding about asthma management also play a role. Rural schools are especially underserved, with 45% fewer spacers than urban schools. Parents can help by asking for the school’s asthma policy, offering to donate a spacer, or connecting with local health organizations for free training and supplies.
Is there a difference between a spacer and a holding chamber?
Technically, yes-but in practice, no. A spacer is a simple tube with no valves. A holding chamber (like the AeroChamber) has a one-way valve that keeps medicine inside until the child breathes in. Most devices sold today are valved holding chambers, but people call them all “spacers.” For children, especially under age 5, a valved chamber is better because it holds the medicine longer and reduces the chance of missing the dose. Both work better than an inhaler alone. The key is using it correctly every time.
What should I do if my child’s asthma worsens at school?
First, make sure the school has a current asthma action plan signed by their doctor. This plan should list symptoms that require immediate treatment and when to call 911. If your child uses their rescue inhaler with a spacer and doesn’t improve within 10-15 minutes, or if they’re struggling to talk or breathe, call 911. Don’t wait. Also, review the plan with the school nurse every six months. Asthma can change quickly, and what worked last year may not be enough now.
