Inhaler spacer | |
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Synonyms | Valved holding chamber (VHC) |
Specialty | Respiratory medicine |
Intervention | Delivery of medication |
Invention date | 1957 |
A spacer is a device used to increase the ease of giving aerosolized medication from a metered-dose inhaler (MDI). It adds space in the form of a tube or "chamber" between the mouth and canister of medication. Most spacers have a one-way valve that allows the person to inhale the medication while inhaling and exhaling normally; these are often referred to as valved holding chambers (VHC).
A number of brand names exist including AeroChamber, InspirEase and Volumatic. They can also be made from a 500 mL plastic bottle, which works just as well. [1]
Spacers help those unable to breathe deeply, as well as those unable to synchronize their breathing so that they inhale just as the MDI is actuated; the latter is known as poor "hand-lung coordination". [2]
The term spacer is often used to refer to any tube-like MDI add-on device. Some spacers (e.g., InspirEase) utilize a collapsing bag design to provide visual feedback that successful inspiration is taking place. Another type (e.g., Volumatic) is transparent plastic in two vase-shaped parts that come together forming a barrel shape. Valved holding chambers (VHC) are commonly called "spacers" as well.
To use an inhaler without a spacer requires coordinating several actions in a set order (pressing down on the inhaler, breathing in deeply as soon as the medication is released, holding your breath, exhaling), and not everyone is able to master this sequence. Use of a spacer, particularly a valved holding chamber, avoids such timing issues. Valved holding chambers are particularly useful for children, people with severe shortness of breath, and those with cognitive impairment. [3]
After removing the MDI's cap, the MDI mouthpiece is inserted into the back of the spacer. The front part of the chamber is closed off by either a mouthpiece or a mask that covers the mouth and nose. To administer the medication, the MDI is depressed once, resulting in the release of one dose of medication. The medication from the MDI is then suspended in the spacer's chamber while the person inhales the aerosolized medication by breathing in and out. The exhaled breath exits the device through the valves rather than entering the chamber. Some spacers are equipped with a whistle, which sounds if the person is inhaling too quickly.
Spacers slow down the speed of the aerosol coming from the inhaler, meaning that less of the asthma drug impacts on the back of the mouth and somewhat more may get into the lungs. [2] [4] In the case of corticosteroids, less residue in the mouth reduces the risk of developing oral candidiasis, a yeast infection. Rinsing the mouth after application of inhaled steroids has a similar effect. [5]
Whereas people with asthma can keep an MDI close-by at all times, the bulkiness of spacers can limit their use outside the home. Some research suggests that homemade spacers, using plastic bottles, may be as effective as commercially made versions, but homemade versions may have more variability. [6]
Snorkeling is the practice of swimming face down on or through a body of water while breathing the ambient air through a shaped tube called a snorkel, usually with swimming goggles or a diving mask, and swimfins. In cooler waters, a wetsuit may also be worn. The snorkel may be an independent item or integrated with the mask. The use of this equipment allows the snorkeler to observe the underwater environment for extended periods with relatively little effort, and to breathe while face-down at the surface.
Aqua-Lung was the first open-circuit, self-contained underwater breathing apparatus to achieve worldwide popularity and commercial success. This class of equipment is now commonly referred to as a twin-hose diving regulator, or demand valve. The Aqua-Lung was invented in France during the winter of 1942–1943 by two Frenchmen: engineer Émile Gagnan and Jacques Cousteau, who was a Naval Lieutenant. It allowed Cousteau and Gagnan to film and explore underwater more easily.
A diving regulator or underwater diving regulator is a pressure regulator that controls the pressure of breathing gas for underwater diving. The most commonly recognised application is to reduce pressurized breathing gas to ambient pressure and deliver it to the diver, but there are also other types of gas pressure regulator used for diving applications. The gas may be air or one of a variety of specially blended breathing gases. The gas may be supplied from a scuba cylinder carried by the diver, in which case it is called a scuba regulator, or via a hose from a compressor or high-pressure storage cylinders at the surface in surface-supplied diving. A gas pressure regulator has one or more valves in series which reduce pressure from the source, and use the downstream pressure as feedback to control the delivered pressure, or the upstream pressure as feedback to prevent excessive flow rates, lowering the pressure at each stage.
Inhalation happens when air or other gases enter the lungs.
In medicine, a nebulizer or nebuliser is a drug delivery device used to administer medication in the form of a mist inhaled into the lungs. Nebulizers are commonly used for the treatment of asthma, cystic fibrosis, COPD and other respiratory diseases or disorders. They use oxygen, compressed air or ultrasonic power to break up solutions and suspensions into small aerosol droplets that are inhaled from the mouthpiece of the device. An aerosol is a mixture of gas and solid or liquid particles.
Ipratropium bromide, sold under the trade name Atrovent among others, is a type of anticholinergic medication which is applied by different routes: inhaler, nebulizer, or nasal spray, for different reasons.
Salmeterol is a long-acting β2 adrenergic receptor agonist (LABA) used in the maintenance and prevention of asthma symptoms and maintenance of chronic obstructive pulmonary disease (COPD) symptoms. Symptoms of bronchospasm include shortness of breath, wheezing, coughing and chest tightness. It is also used to prevent breathing difficulties during exercise.
Budesonide/formoterol, sold under the brand name Symbicort among others, is a fixed-dose combination medication used in the management of asthma or chronic obstructive pulmonary disease (COPD). It contains budesonide, a steroid and formoterol, a long-acting β2-agonist (LABA). The product monograph does not support its use for sudden worsening or treatment of active bronchospasm. However, a 2020 review of the literature does support such use. It is used by breathing in the medication.
Formoterol, also known as eformoterol, is a long-acting β2 agonist (LABA) used as a bronchodilator in the management of asthma and chronic obstructive pulmonary disease (COPD). Formoterol has an extended duration of action compared to short-acting β2 agonists such as salbutamol (albuterol), which are effective for 4 h to 6 h. Formoterol has a relatively rapid onset of action compared to other LABAs, and is effective within 2-3 minutes. The 2022 Global Initiative for Asthma report recommends a combination formoterol/inhaled corticosteroid inhaler as both a preventer and reliever treatment for asthma in adults. In children, a short-acting β2 adrenergic agonist is still recommended.
An oxygen mask is a mask that provides a method to transfer breathing oxygen gas from a storage tank to the lungs. Oxygen masks may cover only the nose and mouth or the entire face. They may be made of plastic, silicone, or rubber. In certain circumstances, oxygen may be delivered via a nasal cannula instead of a mask.
An inhaler is a medical device used for delivering medicines into the lungs through the work of a person's breathing. This allows medicines to be delivered to and absorbed in the lungs, which provides the ability for targeted medical treatment to this specific region of the body, as well as a reduction in the side effects of oral medications. There are a wide variety of inhalers, and they are commonly used to treat numerous medical conditions with asthma and chronic obstructive pulmonary disease (COPD) being among the most notable.
Fluticasone propionate, sold under the brand names Flovent and Flonase among others, is a steroid medication. When inhaled it is used for the long term management of asthma and COPD. In the nose it is used for hay fever and nasal polyps. It can also be used for mouth ulcers. It works by decreasing inflammation.
A metered-dose inhaler (MDI) is a device that delivers a specific amount of medication to the lungs in the form of a short burst of aerosolized medicine that is usually self-administered by the patient via inhalation. It is the most commonly used delivery system for treating asthma, chronic obstructive pulmonary disease (COPD) and other respiratory diseases. The medication in a metered dose inhaler is most commonly a bronchodilator, corticosteroid or a combination of both for treating asthma and COPD. Other medications less commonly used but also administered by MDI are mast cell stabilizers, such as cromoglicate or nedocromil.
Feline asthma is a common allergic respiratory disease in cats, affecting at least one percent of all adult cats worldwide. It is a chronic progressive disease for which there is no cure. Common symptoms include wheezing, coughing, labored breathing and potentially life-threatening bronchoconstriction. There is conjecture that the disease has become more common due to increased exposure to industrial pollutants. Feline asthma can also be attributed to lung damage caused by long-term exposure to second-hand smoke.
A dry-powder inhaler (DPI) is a device that delivers medication to the lungs in the form of a dry powder. DPIs are commonly used to treat respiratory diseases such as asthma, bronchitis, emphysema and COPD although DPIs have also been used in the treatment of diabetes mellitus.
A snorkel is a device used for breathing atmospheric air when the wearer's head is face downwards in the water with the mouth and the nose submerged. It may be either a separate unit, or integrated into a swimming or diving mask. The integrated version is only suitable for surface snorkeling, while the separate device may also be used for underwater activities such as spearfishing, freediving, finswimming, underwater hockey, underwater rugby and for surface breathing while wearing scuba equipment. A standard snorkel is a curved tube with a shape usually resembling the letter "L" or "J", fitted with a mouthpiece at the lower end and made from plastic, synthetic elastomers, rubber, or light metal. The snorkel may have a loop or a clip to attach it to the head strap of the diving mask or swimming goggles, or may be tucked between the mask-strap and the head. Some snorkels are fitted with a float valve at the top to prevent flooding if the top opening is immersed, and some are fitted with a water trap and purge valve, intended for draining water from the tube.
An orinasal mask, oro-nasal mask or oral-nasal mask is a breathing mask that covers the mouth and the nose only. It may be a complete independent item, as an oxygen mask, or on some anaesthetic apparatuses, or it may be fitted as a component inside a fullface mask on underwater breathing apparatus, a gas mask or an industrial respirator to reduce the amount of dead space. It may be designed for its lower edge to seal on the front of the lower jaw or to go under the chin.
Mometasone/formoterol, sold under the brand name Dulera among others, is a fixed-dose combination medication used in the long-term treatment of asthma. It contains mometasone a steroid and formoterol a long-acting beta agonist. It is only recommended in those for whom an inhaled steroid is not sufficient. It is used by inhalation.
The mechanism of diving regulators is the arrangement of components and function of gas pressure regulators used in the systems which supply breathing gases for underwater diving. Both free-flow and demand regulators use mechanical feedback of the downstream pressure to control the opening of a valve which controls gas flow from the upstream, high-pressure side, to the downstream, low-pressure side of each stage. Flow capacity must be sufficient to allow the downstream pressure to be maintained at maximum demand, and sensitivity must be appropriate to deliver maximum required flow rate with a small variation in downstream pressure, and for a large variation in supply pressure, without instability of flow. Open circuit scuba regulators must also deliver against a variable ambient pressure. They must be robust and reliable, as they are life-support equipment which must function in the relatively hostile seawater environment, and the human interface must be comfortable over periods of several hours.
Pulmonary drug delivery is a route of administration in which patients use an inhaler to inhale their medications and drugs are absorbed into the bloodstream via the lung mucous membrane. This technique is most commonly used in the treatment of lung diseases, for example, asthma and chronic obstructive pulmonary disease (COPD). Different types of inhalers include metered-dose inhalers (MDI), dry powder inhalers (DPI), soft mist inhalers (SMI) and nebulizers. The rate and efficacy of pulmonary drug delivery are affected by drug particle properties, breathing patterns and respiratory tract geometry.