Comments on: Treating Asthma on the Cheap

By: Rachel

Rachel — Thu, 24 Sep 2009 15:54:14 +0000

I am so glad I came across this article! I lost my daughter’s spacer, her insurance will not pay for a new one, and I am extremely short on money. I’m going to try your water bottle spacer and hope it works for a day or two until I can buy a real one. Thank you for your creativity!

By: AprilRN

AprilRN — Fri, 17 Jul 2009 15:36:12 +0000

I say, simply, good job! Thinking outside the box.

By: Shalom (R.Ph.)

Shalom (R.Ph.) — Mon, 13 Jul 2009 19:41:01 +0000

Retail costs at the pharmacy where I work:

Aerochamber Plus, innovator product, $45.49
Optichamber Advantage, generic of above: $11.29

Aerochamber with paediatric mask: $61.29
Optichamber with paediatric mask: $24.99

There’s also the Vortex series, which has an aluminum tube that is claimed to be better than the plastic (something to do with anti-static). Also the mask is shaped like a cartoon duck, for whatever advantage that gives. It’s priced a couple dollars above the Optichambers.

Note that all of these require a doctor’s prescription in the USA (”for sale by or on the order of a doctor”). Many insurances here in NJ pay for these on prescription, and those that don’t, will usually cover them as a DME (although these have to be billed differently and we’re not set up for that, we send them to a surgical supply instead).

I had one inner-city patient who just couldn’t get the hang of the spacer, what it was for or how to use it. I finally said, “Look, just think of it as a high-tech version of a bong.” His eyes lit up and he said, “Oh, I get it…” Gotta speak their language.

By: Nancy

Nancy — Mon, 13 Jul 2009 06:30:15 +0000

I’ve had to come up with an improvised spacer. My toddler was having an unexpected asthma attack and when I went to bring him his Pro-Air, I realized the spacer was still sitting on my desk at work. Luckily the daycare was well stocked with arts and craft supplies and I cut down some contact paper applied to construction paper and rolled that into a funnel and taped it up. It worked like a charm to fit over his mouth and nose.

Had he been able to inhale only through his mouth on command, I would have used a bottle like you did.

By: Kim

Kim — Fri, 10 Jul 2009 20:52:52 +0000

There is legitimate research showing the HFA inhalers don’t work as well (although also some argument that this is not all bad as less medication is launched into the back of the throat). There is also legitimate research showing that inhaling ethanol directly into the lungs (several of the HFA inhalers include ethanol in the payload) causes irritation. Patients who “claim” to have trouble with this medication are not all Doing It Wrong.

I’m not sure why we don’t just have breath actuated inhalers for rescue medications as well as prophylaxis…even with an MDI, without a coordinated inhalation the medication goes nowhere. Surely the good people at Glaxo wouldn’t mind taking money from all the HFA malcontents.

By: DefendUSA

DefendUSA — Fri, 10 Jul 2009 20:30:30 +0000

That’s a great idea! instead of using one of the 16oz bottles, they could use the 8 oz shorty with no ribbing on the side and it would be more contained.

By: Memune

Memune — Thu, 09 Jul 2009 22:12:45 +0000

Long time asthmatic here – you can make a decent spacer out of a piece of PVC pipe or even cardboard tubing (paper towel roll). The styrofoam cup also works quite well, especially for infants and small children (it makes it seem like a game).

Agree about albuterol vs Xopenex also. Xopenex doesn’t work as quickly as albuterol, so many pts believe it isn’t working and thus use more of it. I keep both handy as I believe albuterol is better as an immediate rescue.

By: Miss Chevious

Miss Chevious — Thu, 09 Jul 2009 20:12:29 +0000

You can order a spacer here for $13.82:

http://www.jrsmedical.com/SPACER_DEVICES_ACC/INVHC79510/product.aspx

By: Linda

Linda — Thu, 09 Jul 2009 15:50:47 +0000

As of March 2009, California covers albuterol without a TAR. Some county programs will do Xopenex, but you can get a PA within 4 hrs to change to albuterol.

FYI – albuterol inhalers have changed since Jan 2008. They no longer contain CFCs as the propellant (thus the HFA on the end of the name). Patients no longer feel the “puff” they used to feel, so they don’t think they are getting any medication (wrong).

Since the new inhalers are HFA, they should be used with the lips around the mouthpiece – not outside as you’ve described (that was true with the old albuterol inhaler though). It is still best to use it with a spacer though. The newer inhalers for prophylaxis – Advair for example, requires the pt to put the mouthpiece in the mouth since inspiration is the actuator.

Finally, the HFA’s (albuterol, atrovent, etc) now all need to have their inhaler cleaned more frequently. Without the CFCs, the drug & propellant will clog the inhaler faster – another thing older COPDs & asthmatics don’t get & claim they don’t work as well.

Also, I’ve never sold a spacer for $100 – thats gouging or you’ve been told a tall tail. Spacers, even the ones for kids with a mask are only 30-45. Granted, that can be pricey, but if on public assistance, a PA can be done within hours & is always approved for children. And, for those not on assistance, what was the wait time worth to you to wait in an ED?

By: Kim

Kim — Thu, 09 Jul 2009 06:23:44 +0000

I though spacers were discouraged with the new HFA inhalers. I’m pretty sure mine even has some stern wording about not using a spacer right on the canister.