Name of the Procedure:

Spacer, Bag, or Reservoir for Metered Dose Inhaler
HCPCS Code: A4627
Commonly referred to as an "inhaler spacer" or simply "spacer."

Summary

A spacer is a device used with a metered dose inhaler (MDI) to help deliver aerosolized medication directly to the lungs. It serves as a holding chamber, allowing the user to inhale the medication more easily and effectively.

Purpose

The spacer is designed to improve the delivery of inhaled medications, commonly for respiratory conditions such as asthma or chronic obstructive pulmonary disease (COPD). The main goals are to improve medication absorption in the lungs, reduce medication wastage, and minimize side effects by preventing the medication from depositing in the throat or mouth.

Indications

• Respiratory conditions like asthma or COPD.
• Difficulty coordinating the actuation of an inhaler with inhalation.
• Patients who experience side effects from direct throat deposition of medication.
• Children, elderly patients, or individuals with physical limitations affecting inhaler use.

Preparation

• No specific preparation is required.
• Patients should ensure the spacer is clean and dry before use.
• If new to the device, patients may benefit from instruction or demonstration by a healthcare provider to ensure proper use.

Procedure Description

1. Assemble the Device: Attach the spacer to the metered dose inhaler.
2. Prepare the Inhaler: Shake the inhaler well.
3. Insert the Inhaler: Insert the inhaler mouthpiece into the spacer.
4. Exhale Fully: Exhale fully to empty the lungs.
5. Inhale Medication:
   • Press the inhaler to release a puff of medication into the spacer.
   • Immediately place the spacer mouthpiece into your mouth and create a tight seal.
   • Inhale slowly and deeply to draw the medication into your lungs.
6. Hold Breath: Hold your breath for approximately 10 seconds to allow the medication to settle in your lungs.
7. Repeat if Necessary: If more than one puff is prescribed, wait about 30 seconds before repeating the steps.

Duration

The entire process takes about 1-2 minutes per dose.

Setting

• Home.
• Outpatient clinic.
• Any setting where inhalers are prescribed and used.

Personnel

• Used by the patient themselves, often under the initial guidance of:
  • Respiratory therapists.
  • Nurses.
  • Physicians or physician assistants.

Risks and Complications

• Minimal risks when used correctly.
• Potential for improper use, leading to ineffective medication delivery.
• Rare risk of infection if the spacer is not cleaned regularly.

Benefits

• Improved medication delivery to the lungs.
• Enhanced symptom relief and better control of respiratory conditions.
• Reduced side effects compared to direct inhaler use.

Recovery

• No recovery period required.
• Immediate resumption of normal activities.
• Regular cleaning of the spacer is essential to maintain effectiveness.

Alternatives

• Direct use of a metered dose inhaler: Less effective for patients with poor inhaler technique.
• Nebulizer: Provides similar benefits but is bulkier and requires a power source.
• Dry powder inhalers: Alternative for some patients but requires a different inhalation technique.

Patient Experience

• Patients may initially feel a learning curve associated with using the spacer.
• Generally painless, and easy to use with practice.
• Increased comfort due to better medication delivery and reduced throat irritation.
• Pain or discomfort is highly unusual but can be managed by adjusting technique or device.