Innovative bottle spacers to treat asthma

An innovative approach is set to make a huge impact on treating asthma in South Africa, made more critical during the coronavirus pandemic. Asthma treatment is usually given by an inhaler, but to get medication more effectively to the lungs in a crisis, the use of a spacer along with the inhaler, or a nebuliser is required.  Nebulisation, a popular therapy in emergency units, however, aerosolises patients’ secretions which increases the risk of spreading the coronavirus. 

Extraordinary times require extraordinary solutions.  The bottle spacer programme, pioneered at the Red Cross War Memorial Children’s Hospital in Cape Town aims at bridging the gap between expensive commercial spacers and the need in low income communities. The team has tested and evaluated the efficacy of using plastic bottle spacers, which are immediately available, instead of expensive spacers.

This plastic bottle spacer not only allows the medication to work much more effectively, but also has the added benefit of minimising droplets in the air and ultimately reducing the risk to staff and patients becoming infected with the coronavirus.

When one uses an asthma pump directly in the mouth most of the spray hits the back of the throat and does not go into the lungs.  A spacer is a chamber filled with air, with the asthma pump fitting into the back.  When you spray the pump first inside the chamber and then breathe this air into one’s lungs, the spray goes into the deepest part of the lungs where it is needed the most.

“It is amazing how fast behaviour change can happen in a crisis situation. Our nursing staff are impressed that the pump and spacer technique actually works well for patients presenting with tight chest and we hope that if we are able to give patients these bottle spacers to take home, there will be fewer EC visits just for a nebulisation in future,” says Dr Elma de Vries, Senior Family Physician: Heideveld Community Day Centre.

“Since Prof Heather Zar first pioneered bottle spacers back in the late 90s using a manual burning technique, we have been using them at the Red Cross War Memorial Children’s Hospital.  But from just a few hundred units a year, we needed to produce tens of thousands, to facilitate the large-scale use of spacers in the public health service across the country,” Prof Michael Levin, Head of Allergy at Red Cross and project lead, explains.

Polyoak Packaging partnered with Habitat industries to create a custom blow-mould base with an indentation in the shape of an asthma pump nozzle.

“During production when the bottle is blown and the plastic is still soft, air is blasted into the bottle base which creates the inhaler size extrusion. So, after that, the only small manual task is to slice off the end of the indentation leaving a perfect-fit attachment hole for the inhaler.  Polyoak has even been able to include the Allergy Foundation website address on the base of the bottle,” continues Prof Levin.

“This is an example of an innovative boundary spanning project which aims to bring a low cost clinically-effective solution to patients across the province, and potentially the country,” says Dr Anita Parbhoo, Medical Manager at Red Cross War Memorial Children’s Hospital.