Aerochambers and Asthmatics: Do No Harm?

Dr. Jack Leon-Max Mutnick, MD

Author address: 

Stevens Community Medical Center, Morris, MN

Abstract: 

Rationale

Spacers added to metered-dose inhalers improve delivery of medication to lung tissue, but are spacers a harbinger for infection, especially in asthmatic patients already combatting inflammation in the lung?

 

Methods

In a single blind randomized pilot study patients diagnosed with asthma, according to current guidelines, were recruited to determine if the Advantage Optichamber® is a harbinger of microbial or fungal organisms. Patients are started on a metered-dose inhaler (Mometasone/Formoterol) with the Advantage Optichamber® and are having the “spacer” cultured at three sites for bacterial/fungal organisms. Sensitivity of the organisms to antibiotics or antifungal medications is also being evaluated. Culture and sensitivity results are being accumulated at months 1, 4, and 10.

 

Results

Early results show that after 1 month of therapy, cultures of the Advantage Optichamber® show organisms including Methicillin-resistant Staphylococcus epidermidis, Micrococcus luteus, Streptococcus parasanguinis, and gram positive rods. Staphylococcus epidermidis (Methicillin-resistant or –sensitive) shows almost a complete class-resistance to the fluoroquinolones. Fungal results show rare alternaria species isolated.

 

Conclusions

As we develop improved therapies to treat and control asthma, we must look beyond the “mouthpiece” and consider the risks that aerochambers present to our patients. Asthma exacerbations are serious and not without complications, and one must question if aerochamber devices should be impregnated with antibacterial/antifungal chemicals or if these devices should also have a “shelf-life” considering the hazards posed to patients, especially the concern for pulmonary infections due to these devices.

abstract No: 

148
    • AAAAI 2014 (70th)