Commercial versus home-made spacers in delivering bronchodilator therapy for acute therapy in children

Comparison of the bronchodilating effects of albuterol delivered by valved vs. non‐valved spacers in pediatric asthma

“…They reported that changes in peak expiratory flow (PEF) and percentage improvement were comparable among all five groups and that changes in FEV 1 and percentage improvement were also comparable, irrespective of severity of baseline airway obstruction . Also, a recent Cochrane meta‐analysis that compares the efficacy of bronchodilator therapy given via commercially produced spacers (valved holding chambers) with home‐made spacers (non‐valved spacers) in children with acute exacerbation of bronchospasms or asthma did not identify a difference in any outcome between the two type of devices .…”

Randomized trial of spacers in asthma

“…Previous reports suggesting comparable efficacy of homemade and commercial spacers in children with stable asthma 4,5 led to a few studies in children with acute asthma 5, 14-16 . Since the completion of this study, the Cochrane Library has published a protocol in the last quarter of 2005 to evaluate commercial vs home-made spacers for bronchodilator therapy in acute asthma 17 , emphasizing the need for robust data on the suitability of different spacer types in acute asthma care. The present study is likely to fill this gap and contribute high level of evidence required for the systematic review.…”

Question 2: Blast from the past: is oral salbutamol useful in resource-poor settings?

“…He improves with nebulised salbutamol and is ready for discharge home. You suggest a short-acting bronchodilator inhaler, via a water bottle spacer,1 to keep at home, but the parents are unable to afford a metered-dose inhaler (MDI), which is relatively expensive. You have heard of oral salbutamol being sold in nearby pharmacies at lower cost and wonder whether this would be acceptable in this situation.…”

“…(KES=Kenyan shillings.) An additional KES1700 (around £12.14) is necessary if a spacer and mask are required, though a spacer can be substituted by a ‘water bottle spacer’ fashioned by healthcare workers at minimal cost, with success that is well documented 1. The question of whether oral salbutamol is a suitable alternative to inhaled preparations in this setting is highly relevant.…”