Lost in Spacer: How Many Breaths?

Asthma guidelines and manufacturer instructions recommend that children inhale from five to “several” times, using normal tidal breathing, when receiving a dose of medication from a pressurized metered dose inhaler (MDI) attached to a valved spacer. Alternatively, a single maximal inhalation is recommended for certain spacers if children using them are able to perform this maneuver. Using a custom-built device, investigators recorded drug delivery with two to nine tidal breaths and a single maximal inhalation in 118 Australian children (age range, 2–7 years) whose asthma treatment included inhaled steroids. The device simulated each child's breathing pattern from an MDI via various spacers: AeroChamber Plus (small volume, 149 mL), Funhaler …