I suggest always using a spacer if you are using an inhaler, you will get more of the medication in that way. People here use both forms, inhaler/spacer and nebulizer. I was told by a respiratory therapist and a pharmacist that the two forms are equally effective.

No spacer , no nublizer. I use it just like the store hands it to me. I rarely have to use it anyway so I hate all the extra cleaning and all with the spacer. I have enough medical stuff to do.