Reasons most asthmatics don't use spacers

It has been proven that a rescue inhaler like Albuterol works 175% better if used properly with a spacer device. That said, only 20% of asthmatics use their inhaler with a spacer.

Here's my list of why this might be:

1. Grew up in the no spacer era
2. Carrying a spacer is too inconvenient
3. Spacers are too bulky to carry around
4. Laziness
5. Never showed proper inhaler technique
6. Don't know what a spacer is
7. Don't know advantages of spacers
8. Spacers make being discreet impossible
9. Personal preference
10. Don't need 175% more medicine
11. It works just fine without a spacer
12. Can't afford one

Please help me add to this list.