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Evaluation of the new model of spacer "L'Espace" in asthmatic children

Campana G., Allegorico A., Coronella A., Galdo F., Indolfi C., Miraglia Del Giudice M.
Department of Woman and Children and General and Specialized Surgery, Second University of Naples, Naples


Metered-dose inhaler (MDI) represent the most practical and cheap way to deliver inhaled medication in the treatment of bronchial asthma (1) . There are, however, two main issues related to their use: the high speed dispensing, which causes the deposition of the most of the dose on the mouth and the need for a perfect coordination between dispensing and inhalation.

The spacers are devices that are used between MDI and the patient's mouth. In this manner the drug is delivered into the spacer and then inhaled by the patient in order to reduce the coordination problems. Furthermore the spacers are able to reduce the speed and the diameter of the drug particles reducing oro-pharyngeal deposition and increasing the amount of particles in respirable range (2, 3) . All of these benefits are especially useful in children. International guidelines suggest the use of spacers with a mask in children under the age of 4 years (4) . However this is a relative age limitation; the mask is recommended since the child is able to use a device with a mouth-piece.
The best inhalation technique is the “single breath technique”: a single deep and slow inspiratory act, followed by a 10 seconds respiratory pause (4) . If the “single breath technique” becomes difficult in children, it is recommended to perform 5 quiet breathings, bearing in mind that the permanence time of the available drug into the device is about 10 seconds. It is important to spray a puff for time by MDI.
The aim of the study was to evaluate the new model of spacer "L'Espace", in children with mild/moderate persistent asthma, treated with low doses of CSI by MDI + spacer. The new model of spacer "L'Espace" has the following features: ideal volume that enables better suspension and spreading of aerosolized medication; innovative frusto-conical shape with better dynamics of the flow of air medicated; laminated bottom with variable opening that adapts itself to the patient inspiratory act ; coloured conical valve which makes the visual control easier, allowing a correct coordination between the drug delivery and inhaling and allowing counts of breathings ; ergonomic, soft and pleasant to touch masks, designed for pediatric use, make more acceptable the treatment for children and ensure a perfect adhesion to the shape of the face, preventing any infiltration or air exits from the device; high quality standards thanks to the materials with which the device is made, for which it presents itself resistant, durable, fully sterilizable and easy to clean.
Materials and methods
The study was performed at the Center for Respiratory Allergy and Food, Department of Women, the Child and General and Special Surgery, the Second University of Naples. We selected 12 children (6 boys and 6 girls) attended to respiratory and allergy center – Pediatric Clinic II of the Second University of Naples. Al the children are aged between 4 and 6 years and affected by mild to moderate persistent asthma treated with low doses of CSI. All the selected children used for the administration of anti-asthmatic therapy MDI + spacer. At baseline was first evaluated the inhalation technique and then handed the new spacer "L'Espace" upon proof. All the selected children came back again after 7 days for clinical examination and we asked to their parents to evaluate by visual analog scales the new model of the spacer. The questions were about the comfort of the mask, the adherence to the face, the movement of the valves, the effectiveness of the new spacer in comparison to the spacer normally used, and, finally, an overall opinion on the new “L’Espace” .


All the children and their parents returned after seven days. About the first point, that is the comfort of the new spacer, 2 parents assigned a score between 3 and 4, 4 parents have assigned a score of 4, and 5 parents a score between 4 and 5 (with an arithmetic mean of the overall 4.2) (see Fig. 1.A) . About the adherence to the face of the new device, 4 parents assigned a score of 4, 8 and parents a score between 4 and 5 (with an arithmetic average overall of 4.5) (see Fig. 1.B) . About the valves motion, 6 parents assigned a score between 3 and 4, and 6 parents a score between 4 and 5 (with an arithmetic mean of the overall 4) (see Fig. 1.C) . About the effectiveness of the new ”L ' Espace” in comparison to the spacer usually used, 3 parents assigned a score between 3 and 4, and 9 parents a score between 4 and 5 (with an arithmetic mean of the overall 4.5) (see Fig. 1.D) . About the overall judgment on the new "L'Espace", 4 parents have assigned a score between 4 and 5, and 8 parents a rating of 5 (with an arithmetic average overall of 4.8) (see Fig. 1.E) .

Figure 1.


This study shows that by using a visual analog scale from 0 to 5, the new spacer "L'Espace" presents an overall score higher than 4, and is more comfortable and effective than the spacers normally used in the selected families.


1. O’Callaghan C, Barry P. Spacer devices in thetreatment of asthma. BMJ 1997; 314: 1061-1062.

2. Newman SP. Principles of metered-dose inhaler design. Respir Care 2005;50:1177-90.

3. Lavorini F, Fontana GA Targeting drugs to the airways: The role of spacer devices.

Expert Opin Drug Deliv. 2009 Jan;6 (1):91-102

4. Global Initiative for Asthma 2015. The GINA asthma strategy report: what's new for primary care? www.ginasthma.com.



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www.thechild.it Four-monthly Journal of Pediatrics edited by Genetics and Pediatric Association (APIG)
Law March 7th, 2001, n. 62 - Press Register Court of Messina n. 4/2012
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Editorial staff from Genetics and Pediatric Unit - University of Messina