A Rationale for Going Back to the Future: Use of Disposable Spacers for Pressurised Metered Dose Inhalers.

Mark Sanders,Ronald Bruin

doi:10.1155/2015/176194

Mark Sanders, Ronald Bruin

Open Access

https://doi.org/10.1155/2015/176194

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Abstract

The introduction of pressurised metered dose inhalers (MDIs) in the mid-1950s completely transformed respiratory treatment. Despite decades of availability and healthcare support and development of teaching aids and devices to promote better use, poor pMDI user technique remains a persistent issue. The main pMDI user aid is the spacer/valved holding chamber (VHC) device. Spacer/chamber features (size, shape, configuration, construction material, and hygiene considerations) can vie with clinical effectiveness (to deliver the same dose as a correctly used pMDI), user convenience, cost, and accessibility. Unsurprisingly, improvised, low-cost alternatives (plastic drink bottles, paper cups, and paper towel rolls) have been pressed into seemingly effective service. A UK law change permitting schools to hold emergency inhalers and spacers has prompted a development project to design a low-cost, user-friendly, disposable, and recyclable spacer. This paper spacer requires neither preuse priming nor washing, and has demonstrated reproducible lung delivery of salbutamol sulphate pMDI, comparable to an industry-standard VHC, an alternative paperboard VHC, and pMDI alone. This new device appears to perform better than these other VHC devices at the low flow rates thought achievable by paediatric patients. The data suggest that this disposable spacer may have a place in the single-use emergency setting.

Highlights

The introduction of pressurised metered dose inhalers (MDIs) in the mid-1950s completely transformed respiratory treatment
This is right and understandable: significant elements of the healthcare professional service and the respiratory treatment industry are devoted to improving the effectiveness of pMDIs in terms of both use of the best inhalation technique and drug delivered to the lung
In one evaluation of 150 UK healthcare professionals, only 9% could demonstrate all aspects of correct pMDI technique [10]

Summary

Mark Sanders and Ronald Bruin

The introduction of pressurised metered dose inhalers (MDIs) in the mid-1950s completely transformed respiratory treatment. The history and origins of the pMDI have been expertly and thoroughly reviewed [1, 2], and notwithstanding the ubiquity and popularity of these devices [3], commentary and research tend to concentrate on resolution of any devicedelivery shortcomings [4] This is right and understandable: significant elements of the healthcare professional service and the respiratory treatment industry are devoted to improving the effectiveness of pMDIs in terms of both use of the best inhalation technique and drug delivered to the lung. These are interlinked issues: the plume of drug and excipients delivered (truly propelled) at high velocity from the pMDI must synchronise with the breath at the optimum point during the inhalation manoeuvre. In one evaluation of 150 UK healthcare professionals, only 9% could demonstrate all aspects of correct pMDI technique [10]

Pulmonary Medicine

Sealed Open mouth

Findings

Optimal use Suboptimal use