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Published on: August 7, 2017
Spacer microbial contamination and asthma outcomes: case series
Meagan W Shepherd1, Mary Beth Hogan1, Rebecca Hayes1
1Department of Pediatrics, Marshall University Joan C. Edwards School of Medicine, Huntington, WV, USA.
Objective:
The primary method of drug delivery to treat asthma is through pressurized metered dose inhalers (pMDI). Asthma guidelines recommend that providers prescribe a spacer for all patients using pMDI. The objective of this study was to examine whether microbial contamination of spacer devices is associated with poor asthma outcomes.
Methods:
This was a cross-sectional, single-center case series of seven pediatric patients with persistent asthma who had previously been prescribed a spacer. Spacers were swabbed with sterile cotton and samples assessed for bacterial/fungal growth. Parents completed a questionnaire including Asthma Control Test (ACT) and asthma control was assessed by an Allergist/Immunologist physician.
Results:
Two (n = 2) children's parent-completed ACT score indicated poorly controlled asthma and three (n = 3) patients were noted to be poorly controlled by the physician. All but one caregiver reported cleaning the spacer with most reporting (n = 5) that they cleaned their child's spacer monthly and one (n = 1) reporting cleaning it every two weeks. One spacer had detected Candida albicans. There was not a statistically significant association between ACT score and microbial growth (p > 0.05).
Conclusion:
Most spacers in a pediatric sample were not contaminated, despite lack of consistent cleaning, as recommended by spacer manufacturers. Providers and pharmacists should discuss proper cleaning of spacers with caregivers of pediatric patients.
Insights
Microbial contamination of asthma spacers was not linked to poor asthma control in children. Consistent cleaning is recommended by manufacturers, but most spacers remained uncontaminated despite infrequent cleaning.
Area of Science:
- Pediatric Pulmonology
- Infectious Diseases
- Asthma Management
Background:
- Pressurized metered dose inhalers (pMDI) are a primary asthma drug delivery method.
- Asthma guidelines recommend spacers for pMDI use to improve drug delivery.
- The potential impact of spacer microbial contamination on asthma control is not well understood.
Purpose of the Study:
- To investigate the association between microbial contamination of asthma spacer devices and poor asthma outcomes in pediatric patients.
- To assess bacterial and fungal growth in spacers used by children with persistent asthma.
- To correlate microbial findings with asthma control metrics.
Main Methods:
- A cross-sectional, single-center case series involving seven pediatric patients with persistent asthma.
- Sterile cotton swabs were used to collect samples from spacers for microbial analysis (bacterial/fungal growth).
- Parental questionnaires (including Asthma Control Test - ACT) and physician assessments evaluated asthma control.
Main Results:
- Two patients had poorly controlled asthma based on parent-reported ACT scores, and three by physician assessment.
- Only one spacer sample showed microbial growth (Candida albicans).
- No statistically significant association was found between ACT scores and microbial growth in spacers (p > 0.05).
Conclusions:
- The majority of pediatric asthma spacers in this study were not contaminated, even with inconsistent cleaning practices.
- Healthcare providers and pharmacists should emphasize proper spacer cleaning techniques to caregivers.
- Further research may be needed to fully understand the role of spacer hygiene in pediatric asthma management.
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