Presented at the British Thoracic Society December 2018.
Having a child with asthma can be stressful for parents, especially for financially strapped ones struggling to pay for an arsenal of puffers and pills for their child’s treatment. Because of this, those healthcare professionals who recommend spacer chambers may suggest one of many lower-cost versions that are available on the market today. But focusing only on cost may be putting a child’s health at risk.
This was borne out in a recent in vitro study presented at the British Thoracic Society Annual Winter Meeting. 1 Researchers evaluated the gold standard AeroChamber Plus* Flow-Vu* chamber with a lower cost chamber, the Free-Breath device, simulating use in both infants and children. Both chambers have a mask and are suitable for children from 1 to 5 years old. When comparing the potential drug delivery into children’s lungs (using a Flovent 50ug MDI), the Free-Breath device delivered only 55 percent of the drug as compared to the AeroChamber Plus* Flow-Vu * chamber. Most significantly, results showed that the Free-Breath infant device—which is intended for use by children under the age of 18 months —delivered no drug at all.
“This study was a real eye-opener for me,” said Dr. Will Carroll, a Respiratory Paediatrician from Stoke-on-Trent. “I had assumed that if a device was available for prescription, that studies of effectiveness would have been undertaken.”
Global asthma guidelines recommend using a spacer chamber that has documented efficacy in young people 2
Using a spacer chamber is critical for young people to overcome obstacles to the drug making its way to the lungs.
The aerosol contents of an HFA inhaler are under pressure and released quickly, making it difficult to coordinate the inhalation of the particles. As a result, much of the delivered drug is often deposited to the back of the throat, and is then swallowed, increasing the risk of side effects. Spacer chambers are designed to hold the small drug particles in the chamber until the patient is ready to inhale, thus reducing the need for good coordination between inhalation and inhaler actuation.2,3 For infants and young children coordinating inhalation with actuation of the puffer is just too difficult; using a spacer chamber allows a child to breath normally while inhaling the medication through the puffer.
Spacer chamber design can make a difference to delivery.
For example, leakages between the facemask and face can affect inhalation. The AeroChamber Plus* Flow- Vu* chamber has a unique visual feedback feature that helps provide visual assurance of a good facemask seal. The Flow-Vu* inhalation indicator moves with inhalation and allows caregivers to count the number of breaths taken.
Asthma is the most common chronic disease among children.4
While it can begin at any age, most children have their first symptoms at age five. 5 During an asthma attack, the airways become inflamed and swollen, and the muscles around them contract, causing the breathing tubes to narrow and reducing the flow of air in and out of the lungs. Symptoms include coughing, wheezing, chest tightness and difficulties breathing, all of which can affect a young person’s quality of life, causing absences from school or less participation in social activities.
Moreover, severe asthma attacks can be life threatening. According to the World Health Organization asthma accounted for 338,000 deaths in 2015.R
Bottom line? Cheaper spacer chambers may appear to be a more viable option for budget-conscious parents, but they could compromise efficacy.
“A study like this could have important safety implications,” Dr. Carroll stressed. “The key message for doctors and allied health professionals prescribing spacer devices is ‘prescriber beware.’”
For more information, please contact:
Jason Suggett, PhD, BPharm, MBA
Group Director, Science and Technology
Trudell Medical International
Tel.: +1 519 455 7060
1. Bracey A, Suggett J, Nagel M. Assessing different valved holding chambers with facemask for delivered mass to carina with inhaled corticosteroid by pressurized metered-dose inhaler. Presented at The British Thoracic Society Winter Meeting, December 5-7, 2018.
2. Lavorini F, Fontana GA. Targeting drugs to the airways: the role of spacer devices. Expert Opin Drug Deliv 2009;6(1):91-102.
3. Global initiative for asthma (GINA) guidelines 2018. Global strategy for asthma management and prevention.
4. World Heatlh Organization. http://www.who.int/features/factfiles/asthma/en/