For people who suffer from asthma, most treatment involves an “MDI” or “metered dose inhaler.”
I won’t get into all the specifics here, but many people don’t use inhalers correctly which, in turn, significantly decreases the effectiveness of the inhaler. Putting the inhaler in your mouth and actuating it causes a substantial proportion of the medicine to be sprayed either on your tongue, on the roof of your mouth, or on the back of your throat. Ideally, patients should hold the inhaler 2 inches (2-3 finger breadths) in front of their mouth, open their mouth, actuate the inhaler, and then inhale deeply – with their mouth still open. Looks dorky, but that is what gets the most medications into your lungs. Often patients have difficulty coordinating the actions.
Here is a link describing proper MDI use.
Enter the spacer device. The spacer is a hollow chamber that fits on the end of a metered dose inhaler. The dose of medicine is sprayed into the chamber where it forms a mist. The patient then inhales the medicine from the other end of the inhaler so the particles get deeper into the lungs. Here’s a link about use of spacer devices. Use of a spacer device can increase the amount of medication delivered to the lungs by 300%.
While a spacer device can make you better, they’re expensive. You can get them from Canada for $65. In the US, they’re more like $80 to $100. If you lose them or they crack, you’re out another $100 to replace them.
So a patient came to the ED and was having trouble controlling her asthma. I recommended a spacer device to help her – in addition to adding steroids to her regimen. She told me that other doctors had recommended a spacer, but that money was tight and she couldn’t afford one.
So I MacGyvered a spacer device out of the water bottle she had sitting on the bed next to her. Basically, I used a pair of scissors to cut a hole in the bottom of the bottle that would just fit the end of the MDI (this is another version I made at home where the hole is a little too big).
This obviously isn’t an ideal device. Some of the medication will be deposited on the ribbed sides of the bottle. It’s probably a little bigger than it should be as well. But even if it doubles the amount of medication getting into the patient’s lungs, it’s better than using nothing at all.
It would be an interesting study to determine the amount of medication delivered via traditional spacer versus this jury-rigged version. If it helps keep patients breathing, it’s worth it.
UPDATE JULY 18, 2009
Thanks to the research from Allergy Notes! There were a couple of published studies showing no statistical difference between the use of homemade spacers and commercial devices.
See this Cochrane review
Also see this study in Lancet showing “a conventional spacer and sealed 500 mL plastic bottle produced similar bronchodilation, an unsealed bottle gave intermediate improvement in lung function, and a polystyrene cup was least effective as a spacer for children with moderate to severe airways obstruction.”