I personally obsessed about every nut, bolt and washer in these crazy things.

Use a dish washer if possible it consumes less water than manual dish washing.

Additionally, a plain washer may be used when the hole is a larger diameter than the fixing nut.

The spacer is a plastic cylinder that mixes the medication with air, making it easier to receive a full dose of the drug.

These medications can be given either via a metered dose inhaler with a spacer or via a nebulizer with both appearing to be equally effective.