Respira
Respira is a collapsible asthma spacer concept designed to make inhaler use more practical and effective. Traditional spacers, though crucial for improving drug delivery, are often bulky and inconvenient, leading to low adoption despite proven benefits. Inspired by origami, Respira’s foldable design combines portability with optimal airflow. This project details agile prototyping to create a user-friendly solution.
Design a portable, foldable asthma spacer that improves inhaler drug delivery while being easy to carry, maintain, and use on the go.
Context
Asthma affects over 300 million people worldwide, and that number continues to rise, especially in urban environments where pollution, lifestyle, and stress compound the risk. For most patients, metered-dose inhalers (MDIs) are the frontline tools for managing symptoms — delivering bronchodilators or corticosteroids directly to the lungs. But despite their clinical importance, inhalers are only as effective as the way they’re used.
Here's the catch: using an MDI correctly requires a surprising level of coordination — pressing down on the canister and inhaling at just the right moment. Most people, especially children, the elderly, or those in distress, struggle with this. As a result, up to 90% of the medication can end up in the mouth or throat instead of the lungs, leading to poor symptom control and unnecessary side effects like oral thrush and hoarseness.
To solve this, spacers were introduced — tube-like attachments that hold the medication in a chamber, giving users time to inhale slowly and deeply. They work. In fact, studies show that spacers significantly improve medication delivery to the lungs and reduce complications. So, why don’t more people use them? and how can we design a spacer that can be more widely used? This is the problem we set out to solve in this project.
Initial Secondary Research
To better understand the nuances of this problem, we began with secondary research — exploring the broader landscape of respiratory illnesses, inhaler systems, and spacer technologies currently in use.
Inhalers and Spacers 101
Inhalers are medical devices used to deliver medication directly to the lungs, primarily for managing respiratory conditions like asthma and chronic obstructive pulmonary disease (COPD). They are small, portable, and designed to administer a precise dose of medication through an aerosol or powder form.
A spacer is an attachment for a metered-dose inhaler (MDI) that holds the medication after it is released, making it easier for the user to inhale the full dose. It acts as a chamber that suspends the medication, allowing patients to take a slower, deeper breath, which helps the medicine reach the lungs more effectively.
Inhalers and spacers are commonly used in both clinical settings (like hospitals and clinics) and home care environments. They are essential for:
- Emergency asthma attacks
- Daily maintenance therapy for chronic respiratory conditions
- Preventive care for exercise-induced asthma
These devices are crucial for managing symptoms such as wheezing, shortness of breath, and tightness in the chest.
Types of Inhalers
There are several types of inhalers, each suited to different needs:
Some popular brands in India and their price points:
Types of Spacers
Spacers come in various forms to accommodate different patient needs and usage scenarios:
Some popular brands in India and their price points:
Evolution of Spacers
This is just another one of those thing...to see the actual paper, click here.
Our initial research revealed a range of inhaler types and spacer designs. Among them, MDIs paired with Valved Holding Chambers (VHCs) stood out as the most widely used and clinically recommended. Given their relevance and known usability issues, we chose to focus the project on improving this specific combination.
Primary Interviews
Given the short duration of the project, we weren’t able to conduct extensive user interviews. Instead, we reached out to family members, known doctors, and local clinics to gather early insights. Being an asthma patient myself, I was able to relate closely to the challenges users face and bring that perspective into the research. We also visited a few clinics around Ahmedabad, where doctors walked us through the correct techniques for using inhalers with spacers and introduced us to the different types available. These firsthand conversations helped us better understand the practical gaps between clinical instruction and real-world usage.
Proper Technique to use the Spacer
One of the first insights we gathered—shared consistently across multiple doctors—was that most patients never learn how to use the spacer correctly, or even understand its purpose. While the correct technique involves steps like shaking the inhaler, sealing the lips tightly, inhaling slowly, and holding the breath—these instructions are rarely communicated well in practice.
Many doctors admitted that they often skip this part during consultations, especially in high-volume clinics. As a result, even patients who own a spacer often lack the confidence or motivation to use it. This pointed to a major communication gap: the knowledge of how and why to use a spacer exists—but it’s not reaching patients when it matters most.
Step 1: Assemble the Spacer
Firmly push the two halves of the spacer together and twist to lock. A secure assembly prevents leaks and maintains proper airflow alignment.
Step 2: Prepare the Inhaler
Remove the cap from the MDI and shake it well for about 5–10 seconds. Shaking mixes the medication and propellant evenly to ensure consistent dosing.
Step 3: Insert the Inhaler into the Spacer
Firmly place the inhaler mouth-down into the back opening of the spacer. This creates an airtight seal so the full dose enters the chamber during actuation.
Step 4: Release the Dose
Hold the inhaler vertically and press down on the canister once to release a dose into the spacer chamber. This pre-loads the chamber with medication, allowing the user to inhale it gradually rather than timing both actions together.
Step 5: Inhale the Medication
Exhale fully through the mouth before placing the mouthpiece in your mouth. Seal your lips around the mouthpiece (don’t bite it). Breathe in slowly and deeply through the mouth. Remove the spacer and hold your breath for about 10 seconds. Then, exhale normally.
Slow, deep inhalation ensures the medication reaches the lower airways, and holding your breath gives time for the particles to settle in the lungs.
Additional Tips for Proper Spacer Use
- Gargle and rinse after use (especially with steroid inhalers) to prevent throat irritation and infections like oral thrush.
- Clean the spacer once a week using mild soap and let it air-dry—avoid towel drying to prevent static buildup.
- Never fire multiple doses into the spacer at once; always use one puff per inhale.
Structure of the Spacer and Inhaler
Once we understood the typical usage pattern, we started discussing the physical design of the spacer. We asked both users and clinicians how the device might be improved—especially if we made it collapsible.
This raised new concerns: some doctors pointed out that collapsible spacers might compromise airflow quality, or lose their anti-static coating—which helps ensure that the medicine doesn’t stick to the inner walls instead of reaching the lungs. We learned that the internal volume, geometry, and material of the chamber play a critical role in drug delivery efficiency.
We also analyzed each part of the spacer and inhaler setup—from the canister to the mouthpiece—trying to identify which features were essential and which could be reimagined. Could the mouthpiece be redesigned? Could airflow guides be integrated into folds? These questions shaped the early direction of our prototyping phase.
Why do people not use the spacer?
Given the short duration of the project, we weren’t able to conduct extensive user interviews. Instead, we reached out to family members, known doctors, and local clinics to gather early insights. Being an asthma patient myself, I was able to relate closely to the challenges users face and bring that perspective into the research. We also visited a few clinics around Ahmedabad, where doctors walked us through the correct techniques for using inhalers with spacers and introduced us to the different types available. These firsthand conversations helped us better understand the practical gaps between clinical instruction and real-world usage.
To build on that foundation, we initiated a more focused line of inquiry—an effort to understand not just what people do, but why they do it. What stops someone from using a spacer, even when prescribed? What daily habits, perceptions, or frustrations shape their decision? Our aim was to uncover the deeper emotional and behavioral factors that data alone can’t reveal.
We spoke with asthma patients from a range of age groups, two general physicians, a pulmonologist, a school nurse, a couple of caregivers, and even a pharmacy attendant who often interacts with patients picking up prescriptions. These conversations took place informally—in waiting rooms, pharmacy counters, and even living rooms. Most of them were semi-structured, where we followed conversational threads while gently steering toward our key research questions: Do users use spacers regularly? What do they think about them? Are they aware of the benefits? What makes them stop using one?
To make the sessions more tangible, we brought along a few sample spacers, observing how users handled them and discussing what felt intuitive—or frustrating. We also experimented with simple card-sorting activities to understand their priorities: portability, ease of cleaning, cost, social comfort, and visual appeal. One participant ranked “embarrassment” higher than “functionality,” which said a lot about the role design could play in breaking social barriers.
Of course, this wasn’t without its challenges. As a student team, navigating clinical spaces wasn’t always straightforward. But by approaching doctors respectfully and framing ourselves as fellow learners (and patients), we were often welcomed into the conversation. In one small government hospital in Ahmedabad, a pulmonologist even allowed us to sit in during consultations and speak briefly with patients about their spacer use. That mix of professional insight and lived user perspective gave our research both breadth and nuance.
By combining observations, anecdotes, and reflections through affinity mapping and pattern clustering, we started to uncover recurring themes: portability problems, stigma, lack of clarity around usage benefits, and general indifference from clinicians. These insights formed the foundation for our design direction—focused on creating a spacer that fits better into real life, not just into medical guidelines.
These findings from our interviews were further supported by existing research. Despite the well-documented benefits of spacers, their use remains low in both clinical and everyday settings. For example, only 20–30% of pediatric emergency departments reportedly use MDIs with spacers instead of nebulizers, and one survey showed just 21% of Canadian doctors recommended spacer use for wheezing children.
Even when spacers are available, many patients choose not to use them. Studies and product reviews cite a range of reasons—bulkiness, difficulty cleaning, embarrassment in public, and lack of clear guidance from healthcare providers. Many users either forget to carry their spacer or avoid it altogether because it feels inconvenient or awkward.
Interestingly, some clinical studies also found no significant improvement in long-term asthma outcomes for patients using spacers versus those who don’t—especially when the medication itself is already optimized. This may explain why doctors don’t always emphasize their importance. However, other research shows that when patients are properly educated, both spacer use and inhaler technique improve noticeably.
This suggests that the real barriers aren’t about whether spacers work—but whether they’re easy, accessible, and appealing enough for people to actually use in real life.
Final brief: How might we redesign asthma spacers to be more portable, intuitive, and discreet — without compromising on drug delivery effectiveness?
Prototyping
To address the challenge of poor spacer adoption, we split our prototyping process into two focused directions: improving portability and enhancing the overall user experience. We adopted an agile prototyping approach — not just as a workflow, but as a mindset. Instead of aiming for perfect solutions from the outset, we prioritized speed, iteration, and feedback, rapidly sketching and building early concepts to test what worked, what didn’t, and what users actually needed.
Brief 1: Make Spacers More Compact
One of the earliest challenges we tackled was the issue of portability. Traditional valved holding chambers (VHCs) are often bulky, rigid, and not suited for everyday carry. Our design brief here was to explore collapsible or compressible forms that could retain the functionality of a spacer without compromising on durability or airflow. We began with origami-inspired structures — exploring Miura folds, wave geometries, square accordions, and twisting cuboids. These folding patterns were tested for three critical requirements: even expansion, structural stability, and a smooth airflow path from the inhaler to the mouth. Designs like the square accordion offered vertical compression like a camera bellows, while twisting cuboids introduced an engaging, rotational unfolding motion. Some collapsible cuboid patterns folded into flat panels, making them extremely efficient to pack or store.
To go beyond visual form, we prototyped a DIY airflow test using aerosol spray paint inside the models. This allowed us to simulate how medication might flow inside the chamber and observe particle deposition patterns. It helped us identify issues like dead zones, turbulence, or deposition hotspots that would reduce delivery efficiency. Prototypes that seemed promising visually were quickly ruled out through these functional trials. Once promising forms emerged, we transitioned from paper to foldable materials such as laminated board, coated fiber sheets, and textured plastics. These were tested for resilience, fold memory, surface texture (which impacts static charge), and comfort against the mouth or face. This phase helped us narrow down viable structures that could endure repeated folding, resist medication build-up, and remain compact in daily use.
Brief 2: Enhancing the User Experience
Once we had promising structural ideas, our focus shifted to improving the user interaction, especially during high-stress moments like asthma attacks. We started prototyping mechanisms that made the spacer easier to carry, assemble, and use without requiring too much thought or effort. One of the first concepts was a sliding mechanism, inspired by drawer-like packaging, where the spacer expanded through stacked compartments. This design felt intuitive and pocket-friendly. We also experimented with a hinge-based design, where the chamber folded from the side like a clamshell. The mechanical hinge gave tactile feedback, making it easier for users to deploy it with one hand and know it had locked into place. A more experimental prototype involved a balloon-like expansion, where the spacer inflated into shape. While this scored well on softness and comfort, it lacked the internal rigidity required for precise airflow control.
Another direction we explored was the idea of integrating the spacer directly with the inhaler, reducing the friction of carrying two separate devices. The concept involved a spacer that either clipped onto or was stored inside the inhaler — ensuring that it was always available when needed. Across all these iterations, ergonomic testing played a key role. We continuously evaluated how easily the prototypes opened, how secure they felt in the hand, and how reliably they connected to standard MDIs. This process helped us distill which interaction mechanisms aligned best with both clinical needs and user expectations in real-world usage.
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Future Development Considerations
As we moved closer to refining the final concept, several critical engineering and usability considerations came into focus—each influencing material choices, geometry, and long-term feasibility. A major concern was medicine deposition on the inner walls of the spacer due to electrostatic charge, which can significantly reduce drug delivery efficiency. To address this, we explored options for anti-static materials and surface coatings that could minimize particle loss. Alongside this, achieving optimal airflow became a key priority. The internal volume and geometry needed to support smooth, laminar airflow for proper aerosol suspension, while avoiding sharp corners or “dead space” where medication might settle.
When considering valve integration, it was important that any one-way mechanism be low-resistance, reliable, and responsive to different breathing patterns—whether for children, elderly patients, or adults in distress. Additionally, durability and reusability were vital for both collapsible and rigid prototypes. Foldable forms needed to withstand repeated use without compromising function, and if designed for disposability, the materials had to be affordable and environmentally responsible.
Hygiene and ease of cleaning also played a major role. The interior surfaces had to be smooth enough to prevent microbial buildup and easy to rinse, especially for reusable versions. For disposable ones, clear labeling and safe disposal were essential. Finally, we had to ensure compatibility with a wide range of MDI canisters—the mouthpiece needed to fit securely across brand variations. All of this had to be balanced against the realities of manufacturing, including the feasibility of origami folds at scale, tooling constraints, and efficient assembly workflows.
Due to the compressed two-week timeline of this project, we had to rush the development process and leave the solution at a conceptual stage. However, if you're reading this and would like to take this idea further—or collaborate with us to explore it more deeply—feel free to reach out via email. Some of the next steps would involve deeper material testing, airflow modeling, and pilot user trials in clinical or emergency care settings.
Final Results
The final outcome of this project was a conceptual design for an origami-inspired spacer — a collapsible, pocket-friendly solution that could integrate seamlessly with standard MDIs, making it easier to carry and use on the go. Throughout the process, we adopted **agile prototyping** as our core approach — rapidly building, testing, and iterating across multiple design directions. This allowed us to uncover usability challenges and material limitations that wouldn’t have been evident on paper. We showcased the final prototypes at an exhibition held at NID, where we received **valuable feedback from visitors**, including users, designers, and healthcare professionals. Their insights helped validate the direction and opened up new possibilities for future refinement.
One key learning from this project was the value of agile prototyping. Instead of spending time debating which idea was better on paper, we quickly built and tested multiple versions. That hands-on process saved us from endless speculation — the feedback we got from real users was far more revealing than any internal discussion could’ve been. It reminded us that making > arguing.
