Spacers Improve Asthma Outcomes

August 21, 2013

According to the National Institute of Health's National Asthma Education and Prevention Program, all patients taking medium to high doses of inhaled corticosteroids are recommended to use a spacer/holding chamber with a metered dose inhaler (MDI).

Research shows that spacers/holding chambers decrease the amount of medication in the back of the throat and reduce systemic absorption of the medicine1, 2, 3, 4. Additionally, spacers/holding chambers have been shown to increase delivery of medicine to the lungs in those patients with poor MDI technique5, 6. While simple blue tubes are free and better than no spacer at all, they are not as effective in improving delivery in patients who have difficulty coordinating actuation and inhalation. Valved-holding chambers are preferred and are also recommended for use with albuterol MDI rescue inhalers.

Physicians and pharmacists can facilitate usage of spacers/holding chambers by their patients with asthma. It is recommended that practitioners write a prescription for a valved-holding chamber.

Providers should always verify patient benefits. In many cases, spacers and multiple rescue inhalers are a covered benefit for Blue Cross and Blue Shield of Texas (BCBSTX) members, subject to quantity limits. Multiple rescue inhalers may be needed for children that live in two households, need an additional device for the school health office, and/or attend childcare. If you are prescribing multiple rescue inhalers, be sure to describe which locations the medication is kept.

BCBSTX is committed to working with communities to help improve pediatric asthma care. Through a collaboration with the American Lung Association of the Upper Midwest (ALAUM), BCBSTX is supporting the "Enhancing Care for Children with Asthma Project", a program that implements community-based interventions to improve the health outcomes of children with asthma. For more information about the "Enhancing Care for Children with Asthma Project", visit the ALAUM at . If you have questions about spacers and holding chambers, please contact the ALA in Minnesota at 651-227-8014 or 800-LUNG-USA.

The above material is for informational purposes only and is not intended to be a substitute for the independent medical judgment of a physician. Physicians and other health care providers are encouraged to use their own best medical judgment based upon all available information and the condition of the patient in determining the best course of treatment.

Verification of eligibility and/or benefit information is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member's eligibility, any claims received during the interim period and the terms of the member's certificate of coverage applicable on the date services were rendered.

1 Newman SP, Millar AB, Lennard-Jones TR, Moren F, Clarke SW. Improvement of pressurized aerosol deposition with Nebuhaler spacer device. (1984) Thorax 39:935-41.

2 Brown PH, Blundell G, Greening AP,Crompton GK. Do large volume spacer devices reduce the systemic effects of high dose inhaled corticosteroids? (1990) Thorax 45:736-9.

3 Lipworth BJ. New perspectives on inhaled drug delivery and systemic bioactivity. (1995) Thorax 50:105-10.

4 Selroos O, Halme M. Effect of early vs late intervention with inhaled corticosteroids in asthma. (1991) Chest 108:1228-34.

5 Ahrens R, Lux C, Bahl T, Han SH. Choosing the metered-dose inhaler spacer or holding chamber that matches the patient's need : evidence that the specific drug being delivered is an important consideration. (1995) J Allergy Clin Immunol. 96:288-94.

6 Kim CS, Eldridge MA, Sackner MA. Oropharyngeal deposition and delivery aspects of metered-dose inhaler aerosols. (1987) Am Rev Respir Dis 135:157-64.

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