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Review: home-made and commercial spacers did not differ for delivery of inhaled β2 agonists in children with asthma or wheezing

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C Rodriguez-Martinez

Dr C Rodriguez-Martinez, Clínica Colsánitas, Bogota, Colombia; carlos_rodriguez2671{at}


In children with acute asthma or lower airway obstruction attacks, how do home-made and commercial spacers attached to metered-dose inhalers (MDIs) compare for delivering β2 agonists?


Studies selected compared rapid-acting β2 agonists delivered by MDIs attached to home-made spacers with MDIs attached to commercial spacers in children and adolescents <18 years of age presenting to the emergency department (ED) with acute exacerbations of wheezing or asthma. Outcomes included hospital admission, lung function (peak expiratory flow rate [PEFR], oxygen saturation, and respiratory rate), heart rate, clinical score, intensive care unit (ICU) admission, length of ED stay, and need for additional treatment.


Medline, CINAHL, EMBASE/Excerpta Medica, Cochrane Central Register of Controlled Trials, Cochrane Library (Issue 3, 2007), LILACS, and reference lists were searched. Authors and pharmaceutical companies were contacted for randomised controlled trials (RCTs). 6 RCTs (n = 658, age range 2 mo to 18 y) met the selection criteria. Modified Jadad scores ranged from 2 to 4 out of 5.


In 1 RCT, groups did not differ for hospital admission (table). Groups did not differ for changes in PEFR, oxygen saturation, heart rate, clinical scores, or need for additional treatment (table). No studies reported ED length of stay or ICU admission.


Home-made and commercial spacers attached to metered-dose inhalers did not differ for delivering β2 agonists in children with acute asthma or lower airway obstruction attacks.

Home-made v commercial spacers attached to metered-dose inhalers for delivery of β2 agonists in children with acute asthma or wheezing*


Rodriguez C, Sossa M, Lozano JM. Commercial versus home-made spacers in delivering bronchodilator therapy for acute therapy in children. Cochrane Database Syst Rev 2008;(2):CD005536.

Clinical impact ratings: Family/general practice 5/7; Paediatrics 6/7


Pressurised MDIs are difficult to master, and spacers are highly recommended.1 Spacers remove the need for coordinated breathing with inhalation administration and allow medications to reach the oropharynx at a slower velocity and smaller size, which ensures twice the lung deposition of the treatment. Issues related to use of spacers include inconvenience, cost, and lack of training.2 Use of home-made spacers may help address some barriers.

The meta-analysis by Rodriguez et al provides data to support the use of home-made spacers in lieu of commercial spacers in children with acute asthma or lower airway obstruction attacks. Given that commercial spacers are expensive and unavailable in some areas, it is important to find effective alternatives.

Limitations of the systematic review by Rodriguez et al are that only 2 studies included children <4 years of age. This age group has the greatest difficulty using MDIs and benefits from the use of spacers. The studies only assessed children having acute attacks in hospital settings and did not indicate whether parents, older children, or healthcare providers administered the inhalation treatments. Construction and size of the spacer may be important variables but were not addressed.

Further studies should compare the effectiveness of home-made and commercial spacers in home management of asthmatic conditions by families. Next steps should include a comprehensive review of home-made spacers to identify the materials most often used and the training required by care givers and people with asthma.

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  • Source of funding: not stated.

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