Should hydrofluoroalkane (HFA) inhalers be placed at the mouth rather than two finger spaces away? Are spacer devices appropriate for use with HFA inhalers?—BARBARA BRANDT, NP, Boulder, Colo.

Even though the new HFA inhalers have a less powerful spray, the techniques for use have not changed significantly. In fact, a spacer may even enhance effectiveness. Each inhaler has its own specific instructions for priming, cleaning, and checking for fullness. Remember, these new inhalers should not be floated in water to check for fullness, and shaking is an unreliable way to assess the amount of medicine remaining.—Sherril Sego, MSN, FNP (134-7)