Professional guidelines recommend that pMDIs be used with a spacer or valved holding chamber (VHC) but actual use is lagging, with estimates varying from 10% in the UK in 1990 to 46% in Canada in 2008.
In this review article, Spacer devices for inhaled therapy: why use them, and how?1, the advantages and potential disadvantages of using spacers/ VHCs with pMDIs are addressed, including spacer size, type, material, patient interface, and feedback mechanism; the potential impact of spacers/VHCs on drug delivery; and universal recommendations on how patients should use these devices. A few of these findings are highlighted here:
Spacers/VHCs with a facemask interface rather than a mouthpiece might work better for children under 3 years of age, and for those who cannot take slow and measured breaths while using a mouthpiece. The challenge of using facemasks is achieving a tight yet comfortable seal with the face in order to prevent variable drug delivery.
In addition, feedback mechanisms, such as a whistle that sounds if a patient inhales too quickly, help insure correct breathing techniques.
Conclusions
There are advantages to using spacers/VHCs with pMDIs. The authors recommend using these devices for all patients, and call on healthcare professionals to teach patients how to use inhalers and spacers properly. Currently, only ~10% of health workers know how to train patients properly on these devices. The authors also recommend further research on the clinical benefits of spacers/VHCs to determine their cost effectiveness.
AWAKE study results now available
Report of the Patient-Focused Medical Product Development Meeting on Obstructive Sleep Apnea
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