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Homemade Asthma-Relief Device Could Be an Option for Poor Families E-mail
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When an asthma attack occurs, many sufferers use a device - a "spacer" - to increase the chances that rescue medicine travels from an inhaler all the way down to the airways where it is needed. A new review of studies found no difference between the effectiveness of commercially manufactured devices and homemade spacers.

However, the spacers were not tested with the type of inhaler that is now standard in the United States, cautions a spokesman from the American Academy of Allergy Asthma & Immunology (AAAAI) who read the review.

A puff of aerosolized medicine can leave a metered-dose inhaler at nearly 60 miles an hour. It takes some coordinated timing to make sure a good dose of the drug makes it past the tongue and turns the corner at the back of the throat to reach the windpipe.

A spacer slows down the drug particles and can help patients synchronize their breathing better as they pump the inhaler. "Spacers are somewhat forgiving of bad technique, which is important for children," said Dr. Richard Wasserman, an asthma and allergy specialist in Dallas and an AAAAI spokesman.

The review appears in the latest issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

In the United States, the price of a spacer varies widely, from under $10 to more than $30. In limited-resource countries, commercially manufactured spacers are less available and are relatively costly, so doctors sometimes counsel their patients to use a homemade version. Health researchers want to understand if this practice - common in developing countries - is as effective as other treatment methods.

The review culls data from six studies with more than 600 children who were suffering from a serious bout of wheezing or asthma. The reviewers found no significant differences in the two treatment procedures in terms of hospital admissions or need for further therapy. However, the authors write that considering the small number of study participants and the resulting level of uncertainty of the findings, they cannot conclude that homemade spacers and commercially made spacers work equally well.

It is not clear from the review, but Wasserman said he suspects that the inhalers tested in the six trials used chlorofluorocarbons (CFCs). CFCs are an ozone-depleting chemical used to propel medicine into the lungs. In 1987, the United States agreed to phase out production of chemicals that damage the Earth's ozone layer. By 2009, all inhalers must be CFC-free, so medical device manufacturers are already making the change. Most new inhalers use hydrofluoroalkane (HFA) propellant.

"There are certain differences in the characteristics of the two inhalers - particle size, distribution, speed of the particles - which could affect the behavior of the spacing devices," Wasserman said.

The review does not deal with propellants at all: "The biggest issue of uncertainty coming out of this Cochrane is the change of propellant in the inhalers," Wasserman said.

Rodriguez C, Sossa M, Lozano JM. "Commercial versus home-made spacers in delivering bronchodilator therapy for acute therapy in children (Review)." Cochrane Database of Systematic Reviews 2008, Issue 2.

The Cochrane Collaboration is an international non-profit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. Visit for more information.

About Asthma

Asthma occurs when the main air passages of your lungs, the bronchial tubes, become inflamed. The muscles of the bronchial walls tighten, and cells in the lungs produce extra mucus further narrowing your airways. This can cause minor wheezing to severe difficulty in breathing. In some cases, your breathing may be so labored that an asthma attack becomes life-threatening.

Asthma is a chronic but treatable condition. You can manage your condition much like someone manages diabetes or heart disease. You and your doctor can work together to control asthma, reduce the severity and frequency of attacks and help maintain a normal, active life.

Asthma signs and symptoms can range from mild to severe. You may have only occasional asthma episodes with mild, short-lived symptoms such as wheezing. In between episodes you may feel normal and have no difficulty breathing. Some people with asthma have chronic coughing and wheezing punctuated by severe asthma attacks.

Most asthma attacks are preceded by warning signs. Recognizing these warning signs and treating symptoms early can help prevent attacks or keep them from becoming worse.

Warning signs and symptoms of asthma in adults may include:
  • Increased shortness of breath. Due to bronchoconstriction, shortness of breath is a common asthma symptom. Shortness of breath is used to describe a feeling of breathlessness - a feeling that you cannot catch your breath. If you have asthma, you may feel breathless and struggle to get air in and out of your lungs.
  • Wheezing. Wheezing sounds like a whistle or squeak when breathing in, out, or both. This is a common asthma symptom because asthma causes the bronchi to constrict (bronchoconstriction), which reduces the the air flow in and out of the lungs.
  • Disturbed sleep caused by shortness of breath, coughing or wheezing
  • Chest tightness or pain. Chest tightness is a squeezing feeling in the chest during respiration. It may feel as though someone is sitting on your chest.
  • Rapid breathing. Rapid breathing is a common asthma symptom. When breathlessness occurs, you may try to breathe faster to try to get air in and out of your lungs.
  • Increased need to use bronchodilators - medications that open up airways by relaxing the surrounding muscles.
  • A fall in peak flow rates as measured by a peak flow meter, a simple and inexpensive device that allows you to monitor your own lung function.
  • Children often have an audible whistling or wheezing sound when exhaling and frequent coughing spasms.
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