Lost in Spacer: How Many Breaths?

Lost in Spacer: How Many Breaths?

Children inhale as much aerosolized medication through a spacer with two or three regular inhalations as they do with more inhalations.

Asthma guidelines and manufacturer instructions recommend that children inhale from five to "several" times, using normal tidal breathing, when receiving a dose of medication from a pressurized metered dose inhaler (MDI) attached to a valved spacer. Alternatively, a single maximal inhalation is recommended for certain spacers if children using them are able to perform this maneuver. Using a custom-built device, investigators recorded drug delivery with two to nine tidal breaths and a single maximal inhalation in 118 Australian children (age range, 2–7 years) whose asthma treatment included inhaled steroids. The device simulated each child's breathing pattern from an MDI via various spacers: AeroChamber Plus (small volume, 149 mL), Funhaler (small volume, 225 mL), Volumatic (large volume, 750 mL), and a modified soft-drink bottle (valveless, large volume, 500 mL).

For the two small-volume spacers, a mean of about 40% of aerosolized MDI medication was delivered with both two and nine tidal breaths; for the Volumatic spacer, a mean of about 40% was delivered with three and nine breaths; for the soft-drink bottle spacer, about 50% was delivered with two and nine breaths. Most children aged 5 years and older were able to perform a single maximal inhalation, but this method resulted in the same or less drug delivery as the tidal breaths. In fact, the children's single tidal inhalations with a spacer were higher than predicted by their weight and were actually statistically similar in volume to single maximal inhalations.

Comment: To ensure adequate delivery of medication to the lungs, young children should use spacers with their MDIs. Getting some children to use spacers correctly and patiently can be difficult, and, without data on drug delivery, the number of inhalations has been arbitrary. This study gives pediatricians and caregivers practical information about optimal use: two normal tidal inhalations for small-volume spacers and three for large-volume spacers.

— Cornelius W. Van Niel, MD

Published in Journal Watch Pediatrics and Adolescent Medicine January 12, 2011

Citation(s):

Schultz A et al. Aerosol inhalation from spacers and valved holding chambers requires few tidal breaths for children. Pediatrics 2010 Dec; 126:e1493.

Original article (Subscription may be required)
Medline abstract (Free)

Reader Remarks:

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Soda bottle Asthma spacers
Shayn* SurfingBlondie, 13 Jan 2011 10:23 AM EST
Specialty: Other Specialty
Funny to see that the homemade soda bottle spacer worked best- my mom uses one & made me one years... [more]
SODA BOTTLE ASTHMA SPACERS
André Schultz, 18 Jan 2011 11:33 AM EST
Specialty: Pediatric Pulmonology
Modified soft drink bottles will only work well if the user inhales directly after actuating the puffer. When these experiments... [more]
Cheap & Simple
Ravi Rao, Pvt Practice., 25 Jan 2011 12:54 PM EST
Specialty: Oncology
Spacers cost 70$, retail. A lot of expense for what is essentially a plastic tube. I cannot imagine why this... [more]

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