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Medical Forum / Diseases and Disorders / Asthma / March 2005Spacers
My doctor told me to use a spacer and when I picked up my inhalers, a spacer was included. It only fits the Albuterol (oval) not the Qvar (round). Does this mean I don't need to use a spacer with the Qvar? Or are there spacers in different shapes? Sorry, I'm new to this. > My doctor told me to use a spacer and when I picked up my inhalers, a spacer > was included. It only fits the Albuterol (oval) not the Qvar (round). Does > this mean I don't need to use a spacer with the Qvar? Or are there spacers > in different shapes? > > Sorry, I'm new to this. What IS a spacer and why do you use one? I am wondering if I need one. It's a round plastic tube. You insert your inhaler at one end and put the other end in your mouth, then press down on the inhaler. The medicine sprays into the tube and you breathe in. : > My doctor told me to use a spacer and when I picked up my inhalers, a : spacer [quoted text clipped - 7 lines] : : What IS a spacer and why do you use one? I am wondering if I need one. When a person uses an inhaler with optimum technique about half goes into the lungs and the rest is deposited in the mouth. If you use a spacer the percentage goes to something like 80/20 (IIRC). If you are using albuterol the half that goes into your lungs may be ebough and the part that goes into your mouth is probably not doing any harm. So if you are not getting great results then a spacer might help you get more bang for the puff but if you are doing well it may not be worth it. Things are different with an inhaled steroid. In this case the mouth deposition leads to thrush, sore throats, and increased side effects - especially if the dose is increased for better reponses. I don't think the deposition of Qvar is good enough to negate the need for a spacer.  Signature00doc : When a person uses an inhaler with optimum technique about half goes : into the lungs and the rest is deposited in the mouth. If you use a [quoted text clipped - 12 lines] : I don't think the deposition of Qvar is good enough to negate the need : for a spacer. Do you know if spacers come in different shapes? The opening on mine is oval, but the Qvar inhaler has a round opening. Yes, they come in different sizes, types, cost, and effectiveness. In general most people will get a better dose with less side-effects by using a "spacer". Spacer = device that has a more-or-less plain plastic tube with an insertion spot for the MDI. Valved Holding Chambers = device that at first glance looks like a spacer but has a one-way valve in it. This prevents blowing into the unit and blowing away the charge. Many spacers "hard" and only take one type of MDI. Most Valved Holding Chambers (VHS) have a rubber opening and can take any type of MDI. VHS's are generally better, especially if your technique is shaky. There is another category that has you remove the metal cannister and put it in the "spacer" which has it's own activating mechanism. Some of these work ok but are not generally recommended. Do NOT use them for HFA based MDI's (QVAR, Proventil HFA). The actuating mechanism does not work correctly although is appears to do so. If you have FABULOUS technique a spacer isn't as important. Just about NO ONE has fabulous technique. In one study of medical professionals 2/3 - 3/4 of could not exhibit proper technique. I use these medications myself and I ALWAYS use a spacer of some type. Here's basic directions: http://www.getasthmahelp.org/spacer_holding.asp or here http://msrcnet.com/Resources/Pt_Ed/InhalerUse.asp Just do some Goggling on Valved Holding Chambers, types, uses, and you'll find lots of info. Aerochamber, Opti-Chamber, Easivent, are common and good. There are others. You probably have an Ellipse. It's cheap, works very well with Flovent as long as your basic technique is good, and is often distributed BECAUSE it is cheap. FWIW you can make one about as good with a small empty plastic water bottle, a permanent marker to draw the MDI opening shape, and a hot knife to cut the opening on the bottom with. This is done in 3rd world countries where they are unavailable. I teach aerosol device use to medical professionals. I also have cough variant asthma and have tried almost everything out there both professionally and personally. I know of what I speak. Fritz Merkel Respiratory Care Practitioner Asthma and Allergy Foundation of America-Wa Branch http://www.aafawa.org/ > Yes, they come in different sizes, types, cost, and effectiveness. In general > most people will get a better dose with less side-effects by using a "spacer". [quoted text clipped - 46 lines] > Asthma and Allergy Foundation of America-Wa Branch > http://www.aafawa.org/ I used to have a couple of spacers that were small and fit well into my pocket They are clear plasticm about the size of an albuterol inhaler with a bulge in the middle. The openings on either side are different so they can fit in different inhalers. I loved them because they fit nicely in my pocket. The ones I get from my pharmacy are big round cylinders with a reed that makes a noise when you suck too hard. They are bulky and will not fit in the pocket of anything I have. I need to use a fanny pack. Any ideas where I can get a small spacer? Size is important. Neither too small or too big is desirable. If you are talking about CFC based albuterol use you might like the Optihaler http://rx.health.arizona.edu/optihaler.htm (one bit of information-do a search, lots of hits) They are NOT a VHC, they are a spacer. They should not be used with QVAR or Proventil HFA. Not good for younger children or people with serious MDI use flaws. Not bad for competent adults. The restricted inhalation forces people to slow down the inhalation, a very common problem. If you hear that reed making noise you are inhaling too fast. That's what it's there to tell you. Since inhaled steroids should be on a maintence schedule and not carried around for "rescue use" the larger VHC like you describe are superior for this use as they can be left at home. Fritz > The ones I get from my pharmacy are big round cylinders with a reed > that makes a noise when you suck too hard. Any ideas > where I can get a small spacer? What is MDI? : Yes, they come in different sizes, types, cost, and effectiveness. In general : most people will get a better dose with less side-effects by using a "spacer". [quoted text clipped - 46 lines] : Asthma and Allergy Foundation of America-Wa Branch : http://www.aafawa.org/ MDI = Metered Dose Inhaler (puffer) CFC = chlorofluorocarbon (freon), the propellant in older MDI's. Banned by worldwide treaty and supposed to go away completely soon. That's why you are seeing DPI's = dry powdered inhalers HFA = hydrofluoroalkane, propellant in QVAR and Proventil HFA-replaces CFC's and by most accounts works better. Has a completely redesigned nozzle (actuator) which is why is doesn't work well in actuator based MDI's. Fritz : MDI = Metered Dose Inhaler (puffer) : [quoted text clipped - 7 lines] : : Fritz Thanks. This is all so new to me. > : MDI = Metered Dose Inhaler (puffer) > : [quoted text clipped - 12 lines] > > Thanks. This is all so new to me. Me too. Deposition in the lung without a spacer is more like 10%. With a spacer and good technique it may get up to 20%. Spacer both increase lung deposition and significantly decrease upper airway deposition (mouth, throat, vocal cords), especially important for steroid use. I found the link I wanted finally describing many of the different spacer devices with picture links. http://www.peds.arizona.edu/allergyimmunology/southwest/devices/spacers/spacer.html Fritz Merkel Respiratory Care Practitioner Asthma and Allergy Foundation of America-Wa Branch http://www.aafawa.org/ BTW, EZ Spacers are TERRIBLE. They actually inhibit particle deposition. Ace, Ez Spacer, Inspirease, and Medispacer are examples of spacers that require removal of the MDI cannister. Not recommended though some may work OK with CFC MDI's. Fritz I was given an Aero Chamber Plus at Kaiser. Is that a good one? : BTW, EZ Spacers are TERRIBLE. They actually inhibit particle deposition. : [quoted text clipped - 3 lines] : : Fritz Aerochambers are fine. Wash them in clean soapy water once in awhile. Do not rinse, let drain and dry while covered. The micro-film of soap left behind stops the static cling that traps some of the desirable particles. This is more of a problem with new units and goes away with use anyway. I recommend washing new units but this information almost never gets to first time users. It's good information for medical professionals who may be instructing patients for the first time. Fritz > I was given an Aero Chamber Plus at Kaiser. Is that a good one? > When a person uses an inhaler with optimum technique about half goes > into the lungs and the rest is deposited in the mouth. If you use a [quoted text clipped - 12 lines] > I don't think the deposition of Qvar is good enough to negate the need > for a spacer. Good to know. > I don't think the deposition of Qvar is good enough > to negate the need for a spacer. I may need to correct myself on that one. It is an "HFA" type of inhaler. The one other on the US market, Proventil HFA, has a softer puff and so is generally not used with a spacer (and the lips are placed right on it). The package insert basically instructs via the pictures to use this one in the same way (but many regular inhaler instructions erroneously picture the same technique). The other thing that caught my attention is the round opening - it is the same as the Proventil HFA - so I wonder if they are making them that way so that they won't fit into spacers. You still should rinse your mouth after using it. Signature00doc The nature of the HFA MDI's is a softer puff due to the different propellant and the redesigned nozzle. The do seem to be superior in having a more consistent and effective particle size, a broader temperature range, and some studies indicate better deposition. So, again, if your technique is absolutely flawless you may be able to get away without a spacer. I personally use Qvar, I also use a VHC with ALL MDI's. There seems to be a push (marketing based in my opinion) to convince Docs and patients that a spacer is not needed, thus making their product simpler, more seemingly effective and more desirable. I think this has a bit of truth but still recommend spacers. See my earlier post about different kinds of spacers. Most of the good ones have a rubber opening and will take any MDI. Fritz > There seems to be a push (marketing based in my opinion) > to convince [quoted text clipped - 3 lines] > desirable. I think > this has a bit of truth but still recommend spacers. I agree. Getting the spacer is a hassle that often involves using a different source (respiratory supply or durable medical goods supply rather than the pharmacy) and extra expense and so it is a pain to get patients to get one. Then there are the issues with keeping them. carrying them. and cleaning them. In the end not having to use a spacer (or having it built right in) is a plus so the drug comapnies, rightly or wrongly, are trying to push that angle. I've never seen a study with HFA inhalers - just heard the drug companies saying they don't need it. I can imagine ways that using a spacer with an HFA inhaler (not a CFC one) may increase or decrease the lung delivery so it would be nice to see some actual data. > See my earlier post about different kinds of spacers. Most > of the > good ones have a rubber opening and will take any MDI. I haven't tried cramming an HFA into an aerochamber. The opening is rubber but the hole is oval. I'm not sure how much effort it would take to make it fit. I also have seen some all plastic ones that fit most inhalers fairly well but I am sure would have trouble with the HFA's. Signature00doc |
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