Taking inhaler and bulky spacer everywhere for my 1 yr old - is there a smaller spacer available?

[SeamStitch]

Just wondering if there is an alternative to the standard spacer they give out, like a travel version? I've never seen one so I guess there isn't but though it was worth asking.

Yes.

Aerochambers are smaller than Allen & Hanbury Volumatic spacers.

However one manufacturers inhalers tend to be tied to their spacer device so to change your spacer you often need to change inhaler - if you are just on Salbutamol this is generally straightforward but if your child has brown (steroid) inhalers too equivalency can become slightly more tricky.

Google aerochamber infant and you will see what I mean.

Depends what you have at the moment, if it is the big,clear rather bulbous shaped one then yes there is a better one, it is a cylinder about 20cm long with a mask on the end, we have had a clear plastic and metal versions of these.

I think the big one is meant for ventolin isn't it? And the smaller one (I don't know if it's aerochamber) is for the brown one. The ventolin fits with the other one though, so for carrying round I tend to use that.

<a class="break-all" href="http://www.google.co.uk/imgres?q=volumatic+spacer&um=1&hl=en&sa=N&biw=1024&bih=509&tbm=isch&prmd=imvns&tbnid=UCn9FiNVfRvycM:&imgrefurl=www.midmeds.co.uk/volumatic-spacer-device-p-4322.html&docid=T-PxlJOAqSaF0M&imgurl=www.midmeds.co.uk/images/Volumatic-Spacer-2a.jpg&w=800&h=800&ei=YAGcTtTKMov5sgba_6ztAw&zoom=1&iact=rc&dur=378&sig=109128702486392266285&page=1&tbnh=145&tbnw=145&start=0&ndsp=9&ved=1t:429,r:1,s:0&tx=68&ty=74" rel="nofollow" target="_blank">This is what we currently have but its so big.

We have to take it everywhere for the Salbutamol nhaler and later this week I think we are getting the steriod brown inhaler next week when we go back for a follow up, but think that would just be each morning at home so can use the big bulky one for that. Its just that the big spacer is massive to take everywhere, plus the allergy meds we have too I feel like a pack horse!

Off to google aerochamber, would they be ok for a 1 year old?

I've found this, is that what you mean?

Hi, I had the aero chamber (just the same as the link one) for both my boys inhalers, much small than the one shaped like a zeppalin! It does fit any allen and Hanbury inhalers, and also most of the other brands will also fit with a little jiggling. Made our lives a great deal easier.

Thanks that is good to know, I think we'll get one. Any idea which size I would get for a 15 month old? ChemistDirect have them for Infant or for Child but I don't know what age infant goes up to?

this is an opinion, lets see what other opinions there are...

I have experience of the Volumatic, which is huge. What it aims to do is to get more of the spray into the lungs, and less stuck to the inside of the mouth and so on.

So as I see it, it is a dosage-increasing device.

So if you haven't got it with you for some reason, to get the equivalent dose, you would have to use an extra squirt or something. The dosage prescribed must surely be different depending on whether you are using the spacer or not. Some of the dosages say things like "one or two puffs" or "as required" or "two to four times a day" so there must be room in those cases for taking a bit extra when you aren't using the spacer. That said, I'm very much in favour of following the prescriber's instructions.

Do they still use those green ones that are like a blue one but the effects last far longer? That might reduce the need to use them at inconvenient times of the day.

PigletJohn I don't understand what you are trying to say.

Are you debating whether I would use a spacer or not a spacer? DD is only 15 months so the spacer is the only way to administer her inhaler.

My boys both have an aerochamber. They have the yellow one with a mask. They have never even been offered the enormous A&H one, so I would assume that it would work just as well.

Pigletjohn mentioned a green inhaler (salmeterol) but afaik that is only used if the prescribed doses of ventolin and steroid inhaler don't keep things under control.

I think (correct me if I'm wrong) is that the Volumatic (big inhaler) is more efficient, ie gets more of the dose into the lungs per sqidge of the inhaler.

If you were using the smaller spacers you might need to do an extra sqidge of the inhaler to get the same amount of medication (eg 3 squidges instead of 2).

Because the dosage given isn't reliant on you using a spacer (my db was using inhalers without spacers at 15 months-I don't even know whether they existed back then) then ther dosage given by the doctor isn't exact anyway.

You do need to make sure if you're giving multiple squidges that they give the 5 breathes between each puff; you can't just squidge them all in one go, apparently it doesn't work properly.

DeWe The way the hospital tell us to do it is one puff into the spacer, hold over face for the count of ten, spacer off face for 30 seconds then repeat until all puffs are done. They said we mustn't give more than one puff into the spacer at any one time.

I'd hate to try to get my 15month old to take it without the spacer, she can't breathe in on demand and it would be a pointless exercise, none of it would end up in her lungs at all!

"DD is only 15 months so the spacer is the only way to administer her inhaler"

Sorry I hadn't grasped that.

No the dosing doesn't change dependent on the spacer used. You should always give the dose prescribed. Variable dosing eg 2-4 puffs as required is only suitable for salbutamol which is a reliever inhaler, and so you can vary the dose depending on your symptoms.

Aerochambers are fine for adults and toddlers, but a mask is used for babies, toddlers and small children.

Everyone - adults and children - should use a spacer for their steroid inhaler (ideally) and a spacer is essential for children for salbutamol (Ventolin) and a steroid (brown, orange or purple inhaler).

SeamStitch don't buy a spacer, you can ask for an Aerochamber on prescription when you go for review.

Thanks for that Sidge, thats really clear and helpful. I did ask when we were last in but I was met with blank faces and they said the volumatic was the only one they knew they could prescribe. When we go to the asthma clinic they might be more clued up though so will ask again.

I've been busy searching and reading a few clinical research papers comparing the popular spacers and the big bulky spacer we have seems to be by far the best one for us to use, compared to the smaller ones.

I know this paper is a little old now www.ncbi.nlm.nih.gov/pmc/articles/PMC472565/pdf/thorax00327-0075.pdf but on page 838, graph figure 3, you can see that the big bulky Volumatic delivers more compared to just using the inhaler on its own , the small Aerochamber delivers considerably less compared to just the inhaler. From the text I think the Volumatic delivers 117% compared to inhaler alone, whereas the small Aerochamber only delivers about 43% compared to the inhaler alone, which is a massive difference.

So I think we'd just stick to using the big Volumatic one at home, get a spare one to live in the car and ask for/buy a small one for the change bag. Then we'll always have one to hand, does that sound like a plan?

Yes the large volume spacer such as the Volumatic is the ideal, but as they are not easily portable an Aerochamber can be used too which is far better than just using an MDI alone (which is virtually impossible in children anyway!)

Certainly all spacers reduce oropharyngeal deposition and increase lung deposition hence why their use is encouraged. Not all spacers are prescribable - the Vortex isn't but may be given by a hospital department for example. Volumatics tend to be prescribed because they're very effective, and they're cheap! But I would rather prescribe an Aerochamber and know that it will be used, rather than a Volumatic that will sit and gather dust somewhere (and mean that the child isn't getting their inhalers).

"Certainly all spacers reduce oropharyngeal deposition and increase lung deposition"

well that sound to me as if a bigger dose gets to the lungs with a spacer

Ds has always used an aerochamber, he hated the volumatic (understandable must look scary to a 6 month old lol)

His consultants and nurses all know he uses this and like pp said there is no difference in the amount he gets.

It is also very handy to live in his bag!

Umm, sort of PigletJohn, not exactly a bigger dose, it means more of the prescribed dose will end up in the lungs (where you want it) rather than in the throat and upper airway.

So when we prescribe we have to prescribe with the aim of getting the maximum amount of the prescribed dose right down into the lungs, hence the encouragement to use spacers. It wouldn't be best practice to say "well you need 400m mcg but your technique is crap so have 600 mcg just in case".

My dd has been on asthma meds since she was 19 months. We started off with the yellow (child) one. I remember they tried the orange one on her in the hospital but decided the bigger one was better. She is 5 now and still using the yellow one. I think at 15 months you would need to try both to see which is better for your dd.

I know what you mean about feeling like a pack horse. My dd has asthma, eczema and allergies. Even an overnight stay requires a large medicine bag.

"It wouldn't be best practice to say "well you need 400m mcg but your technique is crap so have 600 mcg just in case". "

But that is what's actually happening, isn't it?

So if the patient didn't have the spacer with them, they'd need to take three squirts instead of two?

DS has always had the yellow spacer since he was 6 months. I didnt realise there was a different one for younger children!

The aerochamber has a rubbery connection to the inhaler, and fits most inhalers. My son and I both have age appropriate aerochambers and all our inhalers fit them both. Ironically however he prefers the volumatic, without the mask. He likes to count the clicking noises the valve makes. He knows that ten good clicks mean he is done for that puff. Got to love four year olds!

We just have to argue the toss over inhaler colours now. He thinks it is unfair I have a purple one with numbers on when he has a boring brown one with no numbers. Logic is being refuted at the minute. Stickers might be the way forward

No they should always take what's prescribed, and for a steroid that would normally be 1 or 2 puffs twice daily. If the patient doesn't have, or doesn't use, a spacer then they should have their technique checked and be informed that by taking it straight into the mouth they won't necessarily be receiving the optimal dose.