Asthma summary

Asthma is very common. Almost 10% of people living in the European Union have a diagnosis of asthma. Among children, asthma is the most common chronic medical condition.

Asthma Treatment

Inhaler devices are used to treat and to prevent asthma. They deliver reliever and preventer drugs directly to the lungs. There are many types of inhaler and they can be used by even the very young. They include (pressurised) metered-dose inhalers (MDIs), dry powder inhalers (DPIs) and soft mist inhaler.

Problems with treatment

Inhalers must be used properly in order to be effective.

• For MDIs and soft mist inhaler, this requires co-ordination of two actions, pressing down on the device with the fingers (actuation) while its open end is held between the lips in order to release a dose of drug followed at the right instant by a normal inhalation to deliver the dose into the lungs. If the actuation and inhalation are not co-ordinated, the drug ends up in the mouth and back of the throat not in the lungs.

• For DPIs, a powerful, fast inspiration of breath is needed in order to deliver the dose of drug into the lungs. Many patients do not have a powerful enough inspiration especially when they are short of breath during an exacerbation of asthma.

No matter which device is chosen, it is essential that the patient can use it effectively. Ineffective use of inhalers is a major cause of asthma treatment failure. This is not limited to children. It is a primary cause of poorly controlled asthma in all patient age groups. Even in those patients able to use MDIs and DPIs effectively, much of the drug dose becomes stuck at the back of the throat (oropharyngeal deposition) instead of travelling down to the lungs to have its effect. Oropharyngeal deposition is especially important to avoid with preventer drugs (inhaled corticosteroids) because the steroids have many side effects (loss of voice, oral candidiasis, cataracts, risk of adrenal suppression).

Improving treatment: using spacers with MDIs

Spacers (holding chambers) help to reduce the problems with MDIs because they remove the need to co-ordinate inhaler actuation with drug inhalation. The MDI is attached to the spacer and the open end of the spacer is placed between the lips. The MDI is then actuated into the spacer and the patient inhales the drug from the spacer. The spacer allows the high-speed spray of drug coming from the inhaler to slow down so there is much less oropharyngeal deposition but there is still enough time to inhale the drug effectively into the lungs. The spacers available currently cannot be used with DPIs.

Problems with spacers

Spacers, including small volume spacers, are bulky (volume range 300mL to about 700mL), not very portable and need to be cleaned so patients tend not to use them. Most are made from hard plastics, are not collapsible or recyclable and have to be incinerated for disposal.

The Aer8 spacer

The Aer8 spacer is for use with MDIs. It is made in Sweden using high quality cardboard from a sustainable resource, Swedish wood pulp. It is large volume (500mL) but is easily portable as it can be popped down to collapse between uses. It is non-static, biodegradable, and environmentally friendly as it has no plastic parts. It lasts for 30 days and does not have to be washed. It is easy to carry.