Improvised MDI Spacer

3-April 2020

You have probably all seen the latest Advisory from the Center for EMS regarding avoiding aerosolizing procedures, particularly the use of nebulized medications.  To do this effectively, you need:

1. A Metered-Dose Inhaler (MDI) - could be from the patient or EMS
2. A spacer to help you deliver the medication - these may be difficult to find
3. A patient who is able to follow instructions and take/hold their breath

So what the heck is a spacer?

A spacer allows the medication from the MDI to stay suspended in the air, making it more likely to be taken deeply into the lungs.  Take a look at this video on how to administer one.

https://commons.wikimedia.org/wiki/File:Spacer_for_MDI_inhalers_therapy.jpg


What if I don't have one?

That is where things get interesting:  In the developing world, there has been lots of innovation around reusing what they have to make spacers.  There are actually several papers that support the non-inferiority of these improvised spacers in medication delivery, including a nice review by the folks at the Cochrane collaborative.

So how do I make one?

There are several videos out there that show how to make one of these spacers.  We like this one the most and recommend playing around with methods (melting vs cutting) and let us know what works the best!

Can we reuse these?

These should be for single-patient use, then discarded.  We are working on guidance for cleaning/reusing MDIs - standby for an update.

Are MDIs on the EMS formulary for us to carry?

We are working on this, but discuss with your medical director if you want to try to procure some

Can hospitals replace these MDIs?

Our stocks are pretty low and we are using conservation methods right now, so presume that these cannot be replaced for now.

https://www.flickr.com/photos/niaid/5950870440

What about the patient's own MDI?  If it were working, why would they call us for help?

Excellent question - typically folks are not using ENOUGH medication and/or they are not delivering that medication effectively via a spacer.

What if a patient is on numerous inhalers, which ones should we use?

At this point, you should be focusing on albuterol or albuterol/ipratropium inhaler administration, but if they take others, PLEASE bring them along with the patient so we can continue to administer them in the hospital if needed.