Q:

9/18/2013
We are using the Aerochamber Z stat spacing device. We have always used one device even for multiple meds like albuterol and fluticasone in the same patient. We now have a provider that says this is not correct. I have attempted to find a study showing cross contamination when one spacer is used for more than on medication but have not had much luck. Can you weigh in?

A:

Thank you for your inquiry.

I am referring your question to Dr. Chet Leach, who is an internationally known expert in the use of inhalation devices for the treatment of asthma. As soon as we hear from Dr. Leach, we will forward his response.

Thank you again for your inquiry.

Sincerely,
Phil Lieberman, M.D.

We have received a response from Dr. Chet Leach. Thank you again for your inquiry and we hope this response is helpful to you.

Sincerely,
Phil Lieberman, M.D.

Response from Dr. Chet Leach:
Here is my short answer. I have never heard before that using spacers for multiple products for the same disease indication is an issue and I have never seen any data to that effect. There may of course be a very small entrainment of one drug when chasing it with another but that amount should be at a dose that is probably well below the therapeutic (or side effect) threshold. You can easily mitigate such concerns by cleaning the spacer when switching between drugs or at least at regular recommended intervals. If your daily regimen involves taking a steroid and a beta-agonist then I can't see a concern even if there is a small amount of cross exposure. Another consideration is that having only a single spacer simplifies dosing for patients which of course leads to better compliance. Another factor involves keeping the cost of treatment down by using only one spacer. A final factor would be that spacers that have been previously used and therefore coated usually have better delivery to the patients than new or freshly washed spacers.

I hope this helps answer the question a little.

Chet Leach

AAAAI - American Academy of Allergy Asthma & Immunology