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Spacer devices for inhaled therapy: why use them, and how?

Walter Vincken, Mark L. Levy, Jane Scullion, Omar S. Usmani, P.N. Richard Dekhuijzen, Chris J. Corrigan on behalf of the ADMIT group
ERJ Open Research 2018 4: 00065-2018; DOI: 10.1183/23120541.00065-2018
Walter Vincken
1Respiratory Division, University Hospital Brussels (UZ Brussel), Vrije Universiteit Brussel, Brussels, Belgium
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Mark L. Levy
2Harrow Primary Care Trust, London, UK
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Jane Scullion
3University Hospitals of Leicester, Leicester, UK
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Omar S. Usmani
4Imperial College London, London, UK
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P.N. Richard Dekhuijzen
5Radboud University Medical Centre, Nijmegen, The Netherlands
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Chris J. Corrigan
6Faculty of Life Sciences and Medicine, King's College London/Guy's and St Thomas's NHS Foundation Trust, London, UK
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Tables

  • TABLE 1

    Spacer/valved holding chamber features or characteristics

    Size/volume
    Shape
    Presence of valve(s)
    Material of manufacture
    Mode of interface with the patient
    Presence of feedback devices or mechanisms
    pMDI-specific or universally adaptable

    pMDI: pressurised, metered-dose inhaler.

    • TABLE 2

      Advantages and disadvantages of a spacer/valved holding chamber (VHC)

      Advantages
       Slows down the aerosol cloud as it emerges from the pMDI
        Reduces impact of hand–breath (activation–inhalation) coordination problems
        Longer propellant evaporation time reduces particle size (increases respirable fine-particle fraction) and improves lung deposition
       Filters out larger aerosol particles
        Reduces oropharyngeal impaction/deposition and local side-effects (inhaled corticosteroids)
        Reduces fraction of swallowed drug, gastrointestinal absorption, systemic bioavailability and thus extrapulmonary unwanted effects (β-adrenergic agonists)
       VHCs can be used with tidal breathing, administered by a care giver
        For the very young (using a face mask) and any patient where coordination is a challenge
        During acute exacerbations (replacing nebulisers)
      Disadvantages
       Require regular cleaning
       Large-volume spacer/VHC devices are more bulky and less portable
       Electrostatic charge may reduce the respirable aerosol fraction
       More expensive (but may save medication)

      pMDI: pressurised, metered-dose inhaler.

      • TABLE 3

        Washing and cleaning a spacer/valved holding chamber (VHC)

        1) Disassemble the spacer/VHC after the last dose of the day
        2) Immerse the parts in lukewarm tap water containing a few drops of household detergent
        3) Shake the parts in the water and rub them with a soft cloth
        4) Leave the parts soaking for 15 min, then take them out of the water
        5) Do not rinse or dry rub the inside of the parts
        6) Rinse soapy water off the mouthpiece
        7) Place the parts on a clean towel to air-dry overnight
        8) Reassemble the parts the next morning and check that the valve is not stuck
        9) Wash your spacer/VHC every week
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      Vol 4 Issue 2 Table of Contents
      ERJ Open Research: 4 (2)
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      Spacer devices for inhaled therapy: why use them, and how?
      Walter Vincken, Mark L. Levy, Jane Scullion, Omar S. Usmani, P.N. Richard Dekhuijzen, Chris J. Corrigan
      ERJ Open Research Apr 2018, 4 (2) 00065-2018; DOI: 10.1183/23120541.00065-2018

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      Spacer devices for inhaled therapy: why use them, and how?
      Walter Vincken, Mark L. Levy, Jane Scullion, Omar S. Usmani, P.N. Richard Dekhuijzen, Chris J. Corrigan
      ERJ Open Research Apr 2018, 4 (2) 00065-2018; DOI: 10.1183/23120541.00065-2018
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      • Article
        • Abstract
        • Abstract
        • Introduction
        • Choosing a spacer
        • Assessing the potential impact of spacers/VHCs on drug delivery
        • Recommendations on how to use a spacer/VHC properly
        • Recommendations on spacer/VHC maintenance
        • Conclusions
        • Footnotes
        • References
      • Figures & Data
      • Info & Metrics
      • PDF

      Subjects

      • Asthma and allergy
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