Use of a Tube Spacer to Improve the Efficacy of a Metered-Dose Inhaler in Asthmatic Children FREE

Gary S. Rachelefsky, MD; Albert S. Rohr, MD; Julie Wo, RN; Vickie Gracey, RN; Sheldon L. Spector, MD; Sheldon C. Siegel, MD; Roger M. Katz, MD; M. Ray Mickey, PhD

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Accepted for publication June 27, 1986.

Read before the Annual Meeting of the American Academy of Allergy and Immunology, New Orleans, March 25, 1986.

Reprint requests to 11645 Wilshire Blvd, Suite 600, Los Angeles, CA 90025 (Dr Rachelefsky).

Am J Dis Child. 1986;140(11):1191-1193. doi:10.1001/archpedi.1986.02140250117046.

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ABSTRACT

ABSTRACT | REFERENCES

• Many children with asthma do not use the standard metered-dose inhaler (MDI) skillfully. To improve drug delivery, correct problems of hand-lung incoordination, and reduce local side effects, a number of spacer devices have been developed. We evaluated one such device, a tube spacer (Aerochamber), in 16 asthmatic children (5 to 12 years). On four separate days and in a randomized, double-blind, placebo-controlled manner, they received either metaproterenol sulfate by MDI aerosol (130 μg) or placebo with and without the tube spacer. To maximize techniques, at each visit the children had proper instructions, including viewing a videotape. Spirometry was performed at baseline and 5,15, and 30 minutes, and hourly for six hours, and the patient was monitored. Analysis of the entire group (forced expiratory volume at 1 s and midmaximal expiratory volume) revealed no difference between metaproterenol administered with or without the tube spacer, and both were significantly different than placebo through two hours. Six children had longer and three had better bronchodilatation with the MDI plus tube spacer than with the MDI alone. Side effects and vital signs did not differ between treatments. Under the circumstances of our study, the tube spacer device might enhance the use of the MDI in children who are not properly taught and/or who forget or cannot perform proper technique.

(AJDC 1986;140:1191-1193)

REFERENCES

ABSTRACT | REFERENCES

Epstein S, Manning C, Ashley M, et al: Survey of the clinical use of pressurized aerosol inhalers . Can Med Assoc J 1979;;120:813-816.

Crompton GK: Problems patients have using pressurized aerosol inhalers . Eur J Respir Dis 1982;;63( (suppl 119) ):101-104.

Orehek J, Gayard P, Grimand C, et al: Patient error in use of bronchodilator metered aerosols . Br Med J 1976;;1:76.

Shim C, Williams M: The adequacy of inhalation of aerosol from cannister nebulizers . Am J Med 1980;;69:891-894.

Patterson I, Crompton G: Use of pressurized aerosols by asthmatic patients . Br Med J 1976;;1:76-77.

Lee HS: Proper aerosol inhalation technique for delivery of asthma medications . Clin Pediatr 1983;;22:440-443.

Carr D, Dolovich M, McCormack D, et al: Design and characteristics of a portable breath actuated particle size selective medical aerosol inhaler . J Aerosol Sci 1982;;13:1-7.

Dixon WJ (ed): BMDP Statistical Software . Berkeley, Calif, University of California Press, 1983;.

Konig P: Spacer devices used with metered dose inhalers . Chest 1985;;88:276-284.

Levison H, Reilly PA, Worsley GH: Spacing devices and metered-dose inhalers in childhood asthma . J Pediatr 1985;;107:662-668.

Lindgren SD, Formgren H, Moren F: Improved aerosol therapy of asthma . Eur J Respir Dis 1980;;61:56-61.

Cushley M, Lewis R, Tattersfield A: Comparison of three techniques of inhalation on the airway response to terbutaline . Thorax 1983;;38: 908-913.

Pedersen S: Aerosol treatment of bronchoconstriction in children, with or without a tube spacer . N Engl J Med 1983;;308:1328-1330.

Kjellman NIM, Hidinger KG: Improved efficacy of pressurized terbutaline aerosol in childhood asthma using a spacer . Opucscula Med 1981;;26:47-48.

Ellul-Micallef R, Moren F, Wetterlin K, et al: Use of a special inhaler attachment in asthmatic children . Thorax 1980;;35:620-623.

Tobin M, Jenouri G, Ignascon D, et al: Response to bronchodilator drug administration by a new reservoir aerosol delivery system and a review of other auxiliary systems . Am Rev Respir Dis 1982;;126:670-675.

Rivlin J, Mindorff C, Reilly P, et al: Pulmonary response to a bronchodilator delivered from three inhalation devices . J Pediatr 1984;;104: 470-473.

Hodges IGC, Milner AD, Stokes GM: Assessment of a new device for delivering aerosol drugs to asthmatic children . Arch Dis Child 1981;;56:787-789.

Van Asperen PP, Mellis CM, South RT, et al: The tube spacer in children with asthma . Aust Paediatr J 1981;;17:56-58.

Gurwitz D, Levison H, Mindorff C, et al: Assessment of a new device (Aerochamber) for use with aerosol drugs in asthmatic children . Ann Allergy 1983;;50:166-170.

Oliver CH, Riedel F, Simpson H: Terbutaline in asthmatic children . Br J Clin Pract 1982;;36:157-159.

Becker AB, Simons FE, Benoit T, et al: Terbutaline by metered-dose inhaler: Conventional inhaler versus tube spacer for children with asthma . Ann Allergy 1985;;55:724-728.

Dolovich M, Eng P, Ruffin R, et al: Clinical evaluation of a simple demand inhalation MDI aerosol delivery device . Chest 1983;;84:36-41.

Newman SP, Pavia D, Clark SW: Simple instruction for using pressurized aerosol bronchodilators . J R Soc Med 1980;;73:776-779.

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