Use of spacers for patients treated with pressurized metered dose inhalers: focus on the VENTOLIN™ Mini Spacer

ABSTRACT

Introduction: Spacers offer a multitude of benefits by reducing the requirement to coordinate inhalation with actuation and improving inhaler technique in patients using a pressurized metered dose inhaler (pMDI). Spacers improve drug targeting by retaining within the spacer large particles normally deposited in the oropharynx, and by creating a prolonged aerosol cloud of fine particles to give the user increased time to inhale after actuation. This is particularly important in young children and the elderly to effectively deliver medication to the airways.

Areas covered: By investigating the history and features of spacers, we demonstrate that the advantages of using spacers far outweigh their limitations. We also discuss the optimal characteristics of spacers in terms of shape, volume, presence of valve and static charge, and present a detailed discussion of the VENTOLIN™ Mini Spacer.

Expert opinion: Generally, the shape and size of spacers makes them inherently inconvenient. Consideration of human factors and modern design may make them more attractive to patients. However, the incentive to use spacers should be their ability to help patients correctly use inhaled medications delivered by pMDIs. Understanding of these principles through education is key to their acceptance by patients.

KEYWORDS:

• Asthma
• COPD
• VENTOLIN™ Mini Spacer
• spacers
• pressurized metered dose inhaler
• valved holding device

Article highlights

• Spacers offer advantages to patients using pressurized metered dose inhalers (pMDIs), making them easier to use and improving deposition patterns of the inhaled drug, reducing side effects and improving drug efficacy.

• The function of spacers is dependent on form (shape and volume), construction (inclusion of valves and antistatic coating), and compatibility with the pMDI and drug formulation.

• Used with a salbutamol (Ventolin®) pMDI, the VENTOLIN™ Mini Spacer achieves similar pharmacokinetics as the Aerochamber Plus™.

• Access to spacers is an important part of asthma management and the VENTOLIN™ Mini Spacer provides an affordable option for patients.

• It is the opinion of the authors that spacers are beneficial for patients using pMDIs and, while spacers can be bulky and inconvenient, new spacers, such as the VENTOLIN™ Mini Spacer, can strike a balance between convenience and efficacy.

This box summarizes key points contained in the article.

Declaration of interest

G Anderson, N Johnson, A Mulgirigama and B Aggarwal were employees of GlaxoSmithKline during the conduct of the study and the preparation of the manuscript, receiving personal fees and non-financial support, and holding GlaxoSmithKline stocks/shares. Near the end of manuscript preparation, G Anderson ended his employment at GlaxoSmithKline and began employment at Pharmacentric Solutions. Writing assistance, including development of the initial draft based on author direction, assembling tables and figures, collating authors’ comments, grammatical editing and referencing, was provided by Mary E. Morgan, PhD, of Fishawack Indicia Ltd, UK, and was funded by GlaxoSmithKline. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

The studies described in this review (AC729 and 13-0025) were funded by GlaxoSmithKline (GSK).