Best practice is to use a spacer
Carton Doubles As
A Spacer…
Our patented innovation enables the carton/box to be utilised as a Spacer, enabling better compliance, delivery and ease of use.
As stated by GINA (Global Initiative for Asthma), use of a Spacer improves delivery and with an Inhaled Corticosteroid (ICS) reduces the potential for side-effects.
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- In emergencies
- With better medicine delivery
- Reduced side effects
- Compliance with best practice
- Reduced additional costs
Know More About the MDI PLUS Spacer.
Peer-reviewed Articles
Balancing efficacy and portability: comparative
in vitro/in vivo evaluation of MDI PLUS® versus
AeroChamber2go™ spacers for aerosol delivery
Ahmed H. M. Sobh, Marwa Mohsen, Ahmed M. Abdelfattah, Mohamed E. A.
Abdelrahim & Basma M. E. Mohamed
Published online: 01 Sep 2025
Comparative evaluation of a novel card-based spacer (MDI PLUS®) versus traditional aerochamber plus®: In-vivo and ex-vivo bioavailability study
Assessment of Emergency Spacers Versus Traditional Spacers, An In-Vitro Model for Aerosol Delivery
Omar Ahmed Sayed, Mohamed E.A. Abdelrahim, Nabila Ibrahim Laz & Haitham Saeed
Research Article, Received 03 January 2025, Accepted 21 April 2025, Published: 16 May 2025
Practical Strategies to Improve Asthma Control in Resource-Limited Settings
Haitham Saeed, Hasnaa Osama, Basma M.E. Mohamed, Wesam G. Ammari and Mohamed E.A. Abdelrahim
Evaluation of a cardboard-based Spacer for enhancing aerosol delivery from pressurized metered dose inhalers
Haitham Saeed, PhD ,Wesam G. Ammari, PhD ,Hasnaa Osama, PhD ,Ahmed M. Abdelfattah, MSc ,Mohamed E. A. Abdelrahim, PhD &Basma M. E. Mohamed, PhD
Received 13 Oct 2024, Accepted 03 Feb 2025, Published online: 12 Feb 2025
MDI PLUS – Innovation and Simplicity
What are Spacers?
Spacers, also known as holding chambers or inhaler chambers, are add-on devices used with pressurised metered-dose inhalers (pMDIs) to enhance medication delivery and coordination during inhalation.
These devices, commonly made of plastic, act as an intermediate chamber that holds the medication released from the pMDI, allowing patients to inhale at their own pace and facilitating more of the drug reaching the lungs.
MDI PLUS Manufacturer Benefits
Low-cost Primary Pack Spacer
MDI PLUS is a low-cost Spacer alternative as there is little cost added to the existing required packaging.
Sustainability
MDI PLUS creates a Reuse for the carton packaging and helps to meet CSR commitments.
Best Practice
The MDI PLUS carton Spacer promotes best practice in the importance and benefit of using a Spacer with the manufacturers inclusion of one with the product.
Marketing Opportunities
User-Friendly Design
Compared to other Spacers and using a pMDI alone, the MDI PLUS Spacer is easier to use, requiring fewer training sessions and minimizing mistakes during usage.
Durable Performance
The MDI PLUS Spacer maintains consistent aerosol properties even after multiple uses, ensuring reliable drug delivery over time.
Improved Lung Deposition
The Spacer enhances In-vivo lung deposition, ensuring a higher proportion of the medication reaches the target area, optimizing respiratory treatment outcomes.
Anti-Counterfeiting
Our MDI PLUS solution adds a layer of protection and additional control for manufacturers, through our patented design and our high-tech labelling technology.
Behind the scenes
The Innovation
There are approx. 3.2 million deaths due to chronic obstructive pulmonary disease (COPD) and 495,000 deaths due to asthma, according to the 2017 Global Burden of Diseases Study (GBD). Many millions more suffer from these diseases and would benefit from better drug delivery to the lungs, with the use of a Spacer.
MDI PLUS Ltd. is striving to alleviate this suffering and improve Patients’ lives, through this simple innovative solution.
Like all good innovations the simple ones are the best. MDI PLUS Ltd. discovered a solution to improve pMDI delivery and compliance. We carried out multiple, In-vivo and In-vitro tests and have now proved the hypothesis.
The MDI PLUS spacer is equivalent to the market leading plastic Spacer and is superior to using a pMDI alone.
Benefit your customers and enhance your product marketing with this innovative solution.
Improve Sustainability with MDI Plus.
Our Solution and its Results Compared
Lung Deposition
Ease of Use
Robustness
Lung Deposition
- In-vitro equivalence to market leading plastic Spacer.
- In-vivo superiority to pMDI alone (and equivalence to market leading Spacer)
- Good in-use patient acceptability.
Summary of aerosol properties
| Mean Value (n=3) | pMDI (alone) | AeroChamber | MDI PLUS |
| Fine Particle Dose [µg] | 91.47 | 130.33 | 126.74 |
| MMAD [um] | 4.15 | 4.22 | 3.88 |
| GSD | 1.63 | 1.48 | 1.37 |
Ease of Use
When testing the easiness of the use of pMDI(alone) with MDI PLUS compared to pMDI with Aerochamber and pMDI alone we found that pMDI with MDI PLUS required a lower number of sessions to use it correctly, have a lower number of correctly used steps mistakes compared to pMDI with Aerochamber and pMDI alone.
Number of sessions to correctly use of pMDI and pMDI with spacers (n=20)
| pMDI(alone) | Aerochamber | MDI PLUS | |
| Mean (SD) | 2.15 (0.99) | 2.05 (0.83) | 1.05 (0.69) |
| Median | 2 | 2 | 1 |
| Total number of mistakes | 104 | 135 | 19 |
Robustness
The MDI Plus was shown to deliver a similar amount of aerosol with similar properties after 20 and 50 uses.
Following extensive tests, the MDI Plus spacer was shown to continue to provide, improved performance, against using a measured dose inhaler alone.
Lung Deposition
- In-vitro equivalence to market leading plastic Spacer.
- In-vivo superiority to pMDI alone (and equivalence to market leading Spacer)
- Good in-use patient acceptability.
Summary of aerosol properties
| Mean Value (n=3) | pMDI (alone) | AeroChamber | MDI PLUS |
| Fine Particle Dose [µg] | 91.47 | 130.33 | 126.74 |
| MMAD [um] | 4.15 | 4.22 | 3.88 |
| GSD | 1.63 | 1.48 | 1.37 |
Ease of Use
Ease of Use
When testing the easiness of the use of MDI(alone) with MDI Plus compared to pMDI with Aerochamber and pMDI alone we found that pMDI with MDI PLUS required a lower number of sessions to use it correctly, have a lower number of correctly used steps mistakes compared to pMDI with Aerochamber and pMDI alone.
Number of sessions to correctly use of pMDI and pMDI with Spacers (n=20)
| pMDI(alone) | Aerochamber | MDI Plus | |
| Mean (SD) | 2.15 (0.99) | 2.05 (0.83) | 1.05 (0.69) |
| Median | 2 | 2 | 1 |
| Total number of mistakes | 104 | 135 | 19 |
Robustness
The MDI PLUS was shown to deliver a similar amount of aerosol with similar properties after 20 and 50 uses.
Following extensive tests, the MDI PLUS Spacer was shown to continue to provide, improved performance, against using a measured dose inhaler alone.
MDI PLUS Patient Benefits
Improved Medication Deposition
The MDI PLUS spacer enhances aerosol delivery and compensates for patient coordination issues, ensuring more of the medication reaches the patient’s lungs.
Reduced Systemic Side Effects
The Spacer effectively traps large particles that cause systemic side effects, leading to a decrease in infection side effects when using a pMDI with a Spacer.
Cost-Effectiveness
By using the carton box of the pMDI as the Spacer, the MDI PLUS Spacer reduces costs for patients and remains readily available whenever the pMDI is needed.
Sustainable
The MDI PLUS spacer, is very sustainable as it reduces the need for additional spending, ensures better medication delivery and as a result reduces overuse and waste.
Best Practice
Using any Spacer, reduces the amount of product being deposited in the mouth/throat and enhances better deposition of the medicine in the lungs.
Storage
Storing your inhaler in the box supplied, means you always have a Spacer available for emergencies.
How to use MDI PLUS Carton / Box Spacer
Step by Step Instructions:
- Open Inhaler carton at the top end of the carton, breaking seal/perforations, if it’s a new pack.
- Remove Inhaler and Patient Information Leaflet.
- Remove protective mouthpiece cap and check there is nothing inside Spacer or box.
- Shake the pMDI and insert into the end of the carton.
- Breath out as far as comfortable.
- With the carton closed, bring Spacer up to mouth.
- Depress the inhaler to release the dose at the start of inhalation.
- Maintain a slow inhalation rate until the lungs are full.
- Lower Spacer from the mouth and breathe hold for 5-10 seconds.
- If more than one dose is required, wait about 30 seconds, before the next dose.
- Replace Cap and store back in box / carton, in your jacket, bag or briefcase.
- MDI PLUS box can be used 50+ times.
About Us
David Little
MDI PLUS Ltd. – Managing Director
Print and Packaging Technologist and Independent Packaging Consultant
David has over 35 years’ experience, covering all packaging substrates, including cartons, corrugate, flexible film laminates, rigid plastics, labels and all printing and conversion processes. He is also experienced in Packaging Consultancy & Training, Sales & Marketing, New Product Development, Brand Management, Repro and Capital Equipment.
He has worked across all sectors, including Food & Drink, Pharmaceutical, IT, and Industrial.
David holds the following positions:
- Managing Director of Leonard Little & Associates Ltd. www.leonardlittleassociates.com.
- Chair of the Irish Packaging Society.
- Board Member of ‘IOM3 – The Packaging Society’ (UK).
- Course Director for multiple packaging training courses
- Lecturer in Print & Packaging Technology in Ireland, UK and EU.
- Fellow of the Institute of Materials, Minerals and Mining (IOM3).
Dr. Mohamed EA Abdelrahim
MDI Plus Ltd. – Director of Innovation
Received his PhD from Bradford University, Bradford, UK in 2009 in aerosol therapy. He is listed in the Sanford list of best researchers in the world since 2019 to the present day.
Mohamed has written over 200 published papers and over 80 conference presentations most of them in aerosol therapy. His main area of expertise is Clinical pharmacy and
aerosol
Get In Touch
How to Obtain A License
Our Intellectual Property is currently Patent Pending.
Our IP covers the innovation of using an Inhaler holder, carton or packaging by the addition of apertures or holes, allowing it to be used as a Spacer.
There is room within the IP for manufacturers to personalise the design, board, coatings or tamper evident aspects of the pack or holder.