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We're collecting together information about spacers: what to use, hygiene, educational resources and so on.


Here's a start - please add resources (research, weblinks, tips) that you are aware of:

From Justin R Ortiz MD, MS, Assistant Professor of Medicine & Global Health, University of Washington, Associate Director, International Respiratory and Severe Illness Center (INTERSECT), Division of Pulmonary and Critical Care Medicine, University of Washington Medical Center:

  1.   WHO slideset that includes cleaning recommendations Processing Medical Devices in Settings with Limited Resources:
  2.   " A colleague who works in Kenya wrote:   In Kenya we clean spacers by washing in warm soapy water, followed by a dilute bleach solution and then air drying. Colleagues in South Africa skip the warm soapy water wash and just goes straight for the dilute bleach wash. When I asked how much bleach, I got this response: A 0.5% solution should be fine.  Bleach in the States comes as 5% sodium hypochlorite (so you would make a 1:10 dilution) but this varies  by country so you will need to find out what is locally available and work out the appropriate dilution."

  3. "Less germane to austere settings would be this guidance from the US government and other organizations working in wealthier settings:
    1. Processing the Ipas MVA Plus® Aspirator and Ipas EasyGrip® Cannulae -
    2. Draft Guidance for Industry and FDA Staff Processing/Reprocessing Medical Devices in Health Care Settings: Validation Methods and Labeling: and
    3. APPENDIX A. Overview of Reusable Medical Device Reprocessing
    4. AAMI Reprocessing

  4. Two publications:

    Randomised controlled trial of the efficacy of a metered dose inhaler with bottle spacer for bronchodilator treatment in acute lower airway obstruction

    H J Zar, S Streun, M Levin, E G Weinberg, G H Swingler

    Arch Dis Child 2007;92:142–146. doi: 10.1136/adc.2006.101642

    Accepted 1 August 2006

    Correspondence to: Professor H Zar, Red Cross War Memorial Children’s Hospital, University of Cape Town, 5th floor ICH Building, Rondebosch 7700, Cape Town, South Africa; hzar@

    Background: Inhaled bronchodilator treatment given via a metered dose inhaler (MDI) and spacer is optimal for relief of bronchoconstriction. Conventional spacers are expensive or unavailable in developing countries, but there is little information on the efficacy of low-cost spacers in young children.
Objective: To compare the response to bronchodilator treatment given via a conventional or a low-cost bottle spacer

    Methods: A randomised controlled trial of the efficacy of a conventional spacer compared with a bottle spacer for bronchodilator treatment in young children with acute lower airway obstruction. Bronchodilator treatment was given from an MDI via an Aerochamber or a bottle spacer. Clinical score and oximetry recording were carried out before and after 15 min of treatment. MDI–spacer treatment was repeated up to three times, depending on clinical response, after which nebulisation was used. The primary outcome was hospitalisation.

    Results: 400 children, aged (median (25th–75th centile)) 12 (6–25) months, were enrolled. The number of children hospitalised (n = 60, 15%) was identical in the conventional and bottle spacer groups (n = 30, 15% in each). Secondary outcomes including change in clinical score (22 (23 to 21)), oxygen saturation (0 (21 to 1)) and number of bronchodilator treatments (2 (1 to 3)) were similar in both groups. Oral corticosteroids, prescribed for 78 (19.5%) children, were given to a similar number in the conventional (37 (18.5%)) and bottle spacer groups (41 (20.5%)).

    Conclusion: A low-cost bottle spacer is as effective as a conventional spacer for bronchodilator treatment in young children with acute obstruction of the lower airways.

    Lung deposition of aerosol—a comparison of different spacers

    H J Zar, E G Weinberg, H J Binns, F Gallie, M D Mann

    Arch Dis Child 2000;82:495–498

    Accepted 4 February 2000

    Correspondence to:
 Dr H Zar, Child Health Unit, 46 Sawkins Road, Rondebosch, 7700, South Africa
email: heather@

    Aims: To investigate (1) aerosol lung deposition obtained from two small volume conventional spacers (Babyhaler and Aerochamber) and a home made spacer (modified 500 ml plastic cold drink bottle); (2) the effect of using a face mask or mouthpiece; and (3) the relation between age and pulmonary deposition.

    Methods: Lung deposition of aerosolised technetium-99m DTPA inhaled via spacer was measured in 40 children aged 3–7 years with stable asthma. Each patient performed sequential randomly assigned inhalations using two spacers. Three studies were performed: Babyhaler compared to Aerochamber (with facemasks); Baby- haler with facemask compared to Baby- haler with mouthpiece; and Babyhaler with mouthpiece compared to a 500 ml bottle.

    Results: Median lung aerosol deposition from a Babyhaler and Aerochamber with masks were similar (25% v 21%, p = 0.9). Aerosol lung deposition from a Babyhaler with mask compared to a Babyhaler with mouthpiece was equivalent (26% v 26%, p = 0.5). Lung deposition was higher from a 500 ml bottle compared to a Babyhaler in both young (25% v 12.5%, p = 0.005) and older children (42% v 22.5%, p = 0.003). A notable reduction in pulmonary deposition occurred at 50 months of age.

    Conclusion: A Babyhaler or Aerochamber produce equivalent lung deposition of aerosol. There is no difference in lung deposition when a mask or mouthpiece is used. A modified 500 ml plastic bottle produces greater pulmonary aerosol deposition than a conventional small volume spacer.

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