Spacers with inhalers – do they make a difference?


Published online: January 18, 2017

Patients with asthma are frequently prescribed inhaled corticosteroids (ICS) delivered via a metered-dose inhaler device. Although many patients use their inhalers correctly, many do not, or cannot, carry out the proper inhaler technique required for the medication to reach the lungs. It is generally accepted that patients who cannot master inhaler technique will benefit from adding a spacer, which is a type of holding chamber that attaches to the inhaler and slows the delivery of medication. Spacers are intended to make inhalers easier to use and to deliver medication more efficiently. Despite these potential benefits, there is little evidence of whether spacers improve the effectiveness of treatment. There is especially a lack of evidence in real-life patients, beyond the setting of a monitored clinical trial.

In a study recently published in The Journal of Allergy and Clinical Immunology (JACI): In Practice, Guilbert et al aimed to investigate the effectiveness of spacers when used with two types of ICS, extrafine-particle and fine-particle, in a sample of patients with asthma. This was a real-life study, using historical data from a primary care database in the United Kingdom. Patients were selected from the date at which they were first prescribed ICS medication via metered-dose inhaler. The study relied on evidence of spacer prescriptions and assumed they would be used as prescribed. Patients who were prescribed a spacer were then matched, using a range of demographic and clinical characteristics over the previous year, to similar patients who received the same type of ICS medication but without a spacer. This created the comparison groups, or arms, for the study. Patients were followed for 1 year and their asthma-related outcomes were recorded.

The study included 5,068 patients treated with ICS (2,534 in the spacer arm and 2,534 in the no-spacer arm). During the follow-up year, there was little to no difference in asthma-related outcomes between patients using a spacer and patients not using a spacer, with either extrafine- or fine-particle ICS. Outcomes that were examined included severe asthma exacerbations, the need for reliever medication, and oral thrush, an infection of the throat that can be caused by inhaler use.

This study found no evidence that spacer use led to an improved effectiveness of ICS delivered using a metered-dose inhaler. The authors called for additional research to better understand and confirm their findings. They emphasized the importance of patient education on inhaler technique, whether or not a spacer is prescribed.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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