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Review sets out why and how spacer devices should be used for inhaled therapy

Every patient treated with a pressured metered dose inhaler (pMDI) should own and regularly use a spacer/valved holding chamber (VHC) concludes a new review.

They should know how to use the device properly, both for routine preventer therapy and in an emergency, how to keep it clean and keep an eye out for faults, says the paper by the ADMIT group (Aerosol Drug Management Improvement Team).

The authors, which include Dr Mark Levy, GP and clinical lead of the National Review of Asthma Deaths and Jane Scullion, respiratory nurse consultant and former PCRS-UK trustee, say that extensive studies have shown that when emergency administration of a bronchodilator is indicated for an acute exacerbation of COPD or asthma, the use of a pMDI with a spacer/VHC is at least as effective and safe as nebulised therapy. It may also reduce emergency room waiting times and systemic unwanted effects of bronchodilator therapy.

Compared with nebulised therapy, a pMDI is also cheaper, more convenient, portable and relatively maintenance free.

They point out that despite recommendations in national and international guidelines that pMDIs should be used with a spacer/VHC, they appear to be underused.

They also warn: “An important weakness of pMDI devices, however, is their propensity to be used sub optimally or incorrectly, a problem that has been recognised since their inception and that is unfortunately still prevalent today.  Incorrect pMDI usage may have knock-on effects on efficacy, safety and patient compliance.”

The paper, published in ERS Open Research, provides an overview of the advantages and disadvantages of spacers/VHCs, describes the situations in which a spacer/VHC is most likely to be indicated, and address issues such as correct handling, priming and maintenance. It also sets out 10 practical recommendations on how patients should be taught to use a spacer/VHC properly.

The authors advise that healthcare professionals should ensure they are competent to teach patients how to use and maintain their inhalers properly.

Duncan Keeley, PCRS Policy Lead says: “This is a very important paper. Asthma treatment delivered by pMDI and a spacer has the enormous advantage of remaining effective even in moderately severe attacks. Using a spacer with an pMDI largely overcomes the problems that people have with using inhalers of this type.

“In my view every person with asthma should have a pMDI and spacer even if their regular treatment is with a different inhaler type. This is vital for the most effective self-management of exacerbations. We as health professionals need to make sure that we know how to teach our patients the use of MDI and spacer correctly.”

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Inhaler devices
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