Bronchodilator responsiveness in children with asthma is not influenced by spacer device selection

Abstract

Introduction Spacer devices optimize delivery of aerosol therapies and maximize therapeutic efficacy. We assessed the impact of spacer device on the prevalence and magnitude of bronchodilator response (BDR) in children with asthma. Methods Children with physician confirmed asthma and parentally reported symptoms in the last 12 months were recruited for this study. Each participant completed two separate visits (5‐10 days apart) with spirometry performed at baseline and following cumulative doses of salbutamol (200, 400, 800, and 200 μg) delivered by either a small volume disposable spacer or a large volume multi‐use spacer. Spacer type was alternated for each participant during each visit. The primary outcome was the effect of spacer type on bronchodilator responsiveness. The secondary outcome was to assess the relationships between spacer device, salbutamol dose and the proportion of children with a clinically relevant BDR. Results Thirty‐two children (mean age 11.8 years) completed both visits. Change in lung function following bronchodilators was increased using the large volume spacer, for relative but not absolute increase in FEV1 [mean difference (95% confidence intervals): 1.28% (0.02, 2.54; P = 0.047) and 0.013 L (−0.01, 0.04; P = 0.288)], respectively. There was no observed difference in FVC by spacer type. Overall, 59% (n = 19) of children exhibited a clinically relevant BDR at 400 µg of salbutamol for any spacer and was independent of spacer type. Conclusion Spacer device was not associated with clinically important differences in lung function following bronchodilator inhalation in children with asthma. At a recommended dose of 400 μg, some children with asthma may have their bronchodilator responsiveness misclassified.

From the infant to the geriatric patient—Strategies for inhalation therapy in asthma and chronic obstructive pulmonary disease

“…However, the data is heterogeneous, as some studies did not detect any differences in bronchodilator responsiveness in relation to spacer device selection. 23 VHCs made of antistatic materials should be preferred in order to reduce drug loss caused by drug attraction due to static charge on some plastic spacers.…”

A path to successful patient outcomes through aerosol drug delivery to children: a narrative review

“…Also, VHCs should be used with a facemask instead of a mouthpiece in small children because they don't have the physical ability to seal the mouthpiece during therapy. While the large volume of spacers/VHCs can be an issue in infants and toddlers, no significant difference between small-and large-volume spacers was found on the bronchodilator response of older children with asthma (88).…”

Assessment of a bronchodilator response in preschoolers: a systematic review

“…Five studies did not specify whether a spacer delivered the bronchodilator. Although no significant differences were reported regarding spacer manufacturer, size, or use of facemasks versus mouthpieces for measuring a BDR using spirometry 57,58 , this has not been assessed for other lung function techniques in preschool-aged children. It is recommended that the spacer apparatus be specified for all studies.…”

“…Although the choice of bronchodilator and dosing depends on the clinical question to be answered, it is still an assumption that a clinically significant BDR is similar with SABA doses between 200-600 mcg 54,58 . The time between preBD and postBD testing ranged between 10-20 minutes, with seven studies having no mention in the methods of how long they waited between measurements.…”

“…The time between preBD and postBD testing ranged between 10-20 minutes, with seven studies having no mention in the methods of how long they waited between measurements. A minimum testing interval of 20 minutes is recommended for BDR testing in school-aged children using spirometry, but this has not been studied in preschoolers 58,59 . Our analysis highlights the need for further research comparing different bronchodilator protocols in identical subjects and has been echoed in a recent lung function standards document 6 .…”