Why Pharmacists Should Recommend Asthma Spacers

Pharmacists should recommend asthma spacers to patients taking inhaler therapy for uncontrolled asthma because the devices can help improve hand-breath coordination while reducing side effects of inhaled medication.

Of the 22 million patients with asthma in the United States, between 30% and 70% are nonadherent to treatment. For many, this stems from a lack of understanding about the importance of taking their prescribed medications—namely, inhaled corticosteroids (ICSs).

ICSs are the mainstay long-term medication for asthma control because they decrease the number of asthma exacerbations, symptom frequency, and oral steroid use. They work by inhibiting inflammatory cytokines, thereby decreasing inflammation. This prevents and reduces airway swelling and limits mucus in the lungs.

According to the National Asthma Education and Prevention Program, the following factors most commonly influence asthma control:

• Selecting appropriate medications
• Patient’s willingness to use medications
• Developing a written asthma action plan to guide patients in self-management
• Identifying asthma triggers
• Implementing environmental measures to control allergies, irritants, and pollution when feasible
• Treating comorbid conditions that may exacerbate asthma, such as allergic rhinitis, gastroesophageal reflux disease, obesity, and sleep apnea
• Educating patients about their asthma treatment plan and how to manage their disease

A great deal of asthma treatment nonadherence can be attributed to a knowledge gap about proper device technique.

One study published in the Annals of Allergy, Asthma and Immunology shed some light on the prevalence of incorrect inhaler use among asthma patients. In the study, just 7% of the 44 patients who used metered-dose inhalers (MDIs) showed perfect technique, while 63% missed 3 or more steps. The most common misstep was failing to exhale as much as possible prior to using the inhaler.

Other errors that patients make when using inhalers include not holding their breath for 5 to 10 seconds to allow the medication to settle into their lungs, and not rinsing their mouth after inhalation.

One obvious way to close this knowledge gap and ultimately improve adherence among asthma patients is to recommend a spacer. The Philips OptiChamber Diamond is smaller than most conventional valved holding chambers (VHC) and incorporates a clear, anti-static chamber that gives patients more time to inhale; a high flow whistle that helps patients with their breathing technique; and a low-resistance, highly visible expiratory valve that allows patients to breathe freely and helps measure breath count and breath hold. The VHC’s detachable, kid-friendly LiteTouch mask has a soft-seal interface designed to form to the face and reduce leakage with minimal pressure to comfortably deliver inhaled therapy.

“There are numerous benefits to using spacers, mainly in treating asthma symptoms with fewer adverse effects,” Mary Bridgeman, PharmD, BCPS, CGP, clinical associate professor at the Ernest Mario School of Pharmacy at Rutgers, told Pharmacy Times.

Adverse effects are the most common concern cited among the two-thirds of patients who are apprehensive about using inhaled drugs. These side effects may include thrush, sore throat, hoarseness, and decreased bone thickness in adults. Notably, patients concerned about these adverse effects are more than twice as likely to not adhere to the therapy. However, using a spacer with MDIs can help prevent many of these side effects.

Asthma spacers’ design helps slow down the aerosolized particles released from the MDI, which in turn makes coordination and activation of the inhaler and inspiration of the medication easier for patients. Dr. Bridgeman said using a spacer can also “dramatically reduce the amount of medication that is deposited in the mouth or on the tongue, and improve what’s directly delivered into the airways.”

“Utilizing the spacer allows the patient to achieve better drug delivery into the lungs and airways, as opposed to drug delivery in the back of the throat and the pharynx,” she explained.

Ineffective drug delivery from MDIs alone can lead to rescue inhaler overuse, which is an indicator of poor asthma control and should signal pharmacists to recommend a spacer intervention and educate the patient on proper use. Patient education on asthma management and inhaler use is critical to reduce related hospitalizations, emergency visits, and deaths. Results from various studies show that increasing awareness and promoting education about asthma can reduce the number of related adverse events.