Katie Eder

Pharmacists should recommend asthma spacers to patients taking inhaler therapy for uncontrolled asthma because the devices can help improve hand-breath coordination while reducing side effects of inhaled medication.

Of the 22 million patients with asthma in the United States, between 30% and 70% are nonadherent to treatment. For many, this stems from a lack of understanding about the importance of taking their prescribed medications—namely, inhaled corticosteroids (ICSs).

 for asthma control because they decrease the number of asthma exacerbations, symptom frequency, and oral steroid use. They work by inhibiting inflammatory cytokines, thereby decreasing inflammation. This prevents and reduces airway swelling and limits mucus in the lungs.

According to the National Asthma Education and Prevention Program, the following factors most commonly influence asthma control:

Patient’s willingness to use medications

Developing a written asthma action plan to guide patients in self-management

Implementing environmental measures to control allergies, irritants, and pollution when feasible

Treating comorbid conditions that may exacerbate asthma, such as allergic rhinitis, gastroesophageal reflux disease, obesity, and sleep apnea

Educating patients about their asthma treatment plan and how to manage their disease

A great deal of asthma treatment nonadherence can be attributed to a knowledge gap about proper device technique.

 shed some light on the prevalence of incorrect inhaler use among asthma patients. In the study, just 7% of the 44 patients who used metered-dose inhalers (MDIs) showed perfect technique, while 63% missed 3 or more steps. The most common misstep was failing to exhale as much as possible prior to using the inhaler.

Other errors that patients make when using inhalers include not holding their breath for 5 to 10 seconds to allow the medication to settle into their lungs, and not rinsing their mouth after inhalation.

One obvious way to close this knowledge gap and ultimately improve adherence among asthma patients is to recommend a spacer. The Philips OptiChamber Diamond is smaller than most conventional valved holding chambers (VHC) and incorporates a clear, anti-static chamber that gives patients more time to inhale; a high flow whistle that helps patients with their breathing technique; and a low-resistance, highly visible expiratory valve that allows patients to breathe freely and helps measure breath count and breath hold. The VHC’s detachable, kid-friendly LiteTouch mask has a soft-seal interface designed to form to the face and reduce leakage with minimal pressure to comfortably deliver inhaled therapy.

“There are numerous benefits to using spacers, mainly in treating asthma symptoms with fewer adverse effects,” Mary Bridgeman, PharmD, BCPS, CGP, clinical associate professor at the Ernest Mario School of Pharmacy at Rutgers, told 

Adverse effects are the most common concern cited among the two-thirds of patients who are apprehensive about using inhaled drugs. These side effects may include thrush, sore throat, hoarseness, and decreased bone thickness in adults. Notably, patients concerned about these adverse effects are more than twice as likely to not adhere to the therapy. However, using a spacer with MDIs can help prevent many of these side effects.

Asthma spacers’ design helps slow down the aerosolized particles released from the MDI, which in turn makes coordination and activation of the inhaler and inspiration of the medication easier for patients. Dr. Bridgeman said using a spacer can also “dramatically reduce the amount of medication that is deposited in the mouth or on the tongue, and improve what’s directly delivered into the airways.”

“Utilizing the spacer allows the patient to achieve better drug delivery into the lungs and airways, as opposed to drug delivery in the back of the throat and the pharynx,” she explained.

Ineffective drug delivery from MDIs alone can lead to rescue inhaler overuse, which is an indicator of poor asthma control and should signal pharmacists to recommend a spacer intervention and educate the patient on proper use. Patient education on asthma management and inhaler use is critical to reduce related hospitalizations, emergency visits, and deaths. Results from 

 show that increasing awareness and promoting education about asthma can reduce the number of related adverse events.

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Why Pharmacists Should Recommend Asthma Spacers

Despite current challenges, experts say opportunity for pharmacy is greater now than ever before.

Throughout the Business Program of the 2014 National Association of Chain Drug Stores (NACDS) Total Store Expo in Boston on Sunday, August 26, 2014, Rite Aid Corp Chairman and CEO John Standley; NACDS President and CEO Steven C. Anderson, IOM, CAE; and Ben S. Bernanke, PhD, Former Chairman of The Federal Reserve System, reinforced the reasons for pharmacists to remain optimistic.

“If this moment in time cannot be called a renaissance of health, wellness, and consumer-focused retailing, then no time in our history will ever bear that name,” Anderson 

. “The opportunity is greater right now than ever before.”

Anderson pointed out that opinion research recently commissioned by NACDS demonstrated growing support for new pharmacy services and increasing reliance on pharmacists as dependable information sources concerning prescription drugs, OIC medications, and health questions.

Expanding on that point, Standley, who is also Chairman of the NACDS Board of Directors, 

 that collaboration between retailers and suppliers has helped pharmacies meet the needs of patients, as well as confront current issues in the pharmacy industry.

For instance, Standley related that Rite Aid’s relationship with supplier partners transformed as it became “highly focused on becoming a health and wellness destination, offering services like immunizations and patient counseling that went far beyond filling prescriptions” in order to improve engagement with patients.

“Our transformation is unique, but it also has similarities to what’s occurring at other retailers throughout our industry,” he said. “This is the perfect time for us to come together and challenge ourselves to be better, smarter, and more efficient in all aspects of our business. Our business is shifting and changing, and we must ensure that we change along with it.”

Although he eventually ended up in economics, Dr. Bernanke 

 that he is the grandson and son of pharmacists, so his first job was in the family pharmacy. In his keynote remarks delivered at the second annual NACDS Total Store Expo, Dr. Bernanke, who is currently a Distinguished Fellow in Residence at The Brookings Institution, shared his experience in leading the nation through some of its most challenging financial times, including the Great Recession.

“When you think about who’s best to forecast the nation’s economic and business climate, Dr. Bernanke is hands down the leading authority,” Anderson 

. “Offering NACDS Total Store Expo attendees the opportunity to hear from national leaders such as Dr. Bernanke illustrates NACDS’ commitment to its members in providing timely and relevant programming to help retailers and suppliers meet with success.”

In addition to its morning Business Program, the Total Store Expo provided nearly 2 dozen educational Insight Sessions aimed at helping attendees navigate on a day-to-day basis the Affordable Care Act, emerging health care models, business planning, market trends, health information technology, and digital solutions.

 from Ilisa B.G. Bernstein, PharmD, JD, deputy director of the Office of Compliance with the FDA Center for Drug Evaluation and Research, focused on the implications of the new implementation phases of the Drug Supply Chain Security Act of 2014, while another 

 from leading cyber security experts offered solutions and best practices for protecting against potential data breaches.

“Your engagement is more than just ‘going to NACDS’ — in fact, you are NACDS,” Anderson explained to attendees during the Business Program. “NACDS is playing a major role in positioning this industry in this truly dynamic and historic time, (and) you are playing a major role in positioning this industry because you are NACDS.”