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Asthma - Management
When should a spacer device be used?
- A large-volume spacer is recommended for the administration of inhaled corticosteroids in all children younger than 16 years, and for giving high doses of inhaled corticosteroids (> 800 micrograms of beclometasone or equivalent daily) in adults.
- Consider spacer devices for people who have difficulty coordinating actuation of a pressurized metered-dose inhaler with inhalation.
- Use a pressurized metered-dose inhaler plus a large-volume spacer device as an alternative to a nebulizer in an acute exacerbation of asthma. See Managing acute exacerbations for more information.
Basis for recommendation
- By filtering out larger particles, large-volume spacer devices reduce oropharyngeal deposition of the drug and the amount of drug absorbed from the gastrointestinal tract at all doses [DTB, 2000]. This is particularly important for inhaled corticosteroids because:
- Reducing oropharyngeal deposition of inhaled corticosteroids decreases the incidence of local adverse effects, such as oral candidiasis.
- Reducing the amount of drug absorbed from the gut reduces the risk of systemic adverse effects.
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