TY - JOUR T1 - Spacer device selection may not impact bronchodilator responsiveness (BDR) in asthmatic children JF - European Respiratory Journal JO - Eur Respir J VL - 38 IS - Suppl 55 SP - p1193 AU - Jeanette Langley AU - Claire Shackleton AU - Sunalene Devadason AU - Graham Hall Y1 - 2011/09/01 UR - http://erj.ersjournals.com/content/38/Suppl_55/p1193.abstract N2 - Assessment of spirometry before and after bronchodilators is used in the diagnosis and management of asthma. The impact of spacer device selection on clinical BDR is poorly understood. ATS guidelines state 400μg of salbutamol should be used for BDR testing. The aim of this study was to investigate if spacer selection has an effect on BDR in asthmatic children and at what salbutamol dose BDR reached significance.Methods: This study compared spirometry and BDR with a disposable spacer (Lite Aire; Thayer Medical) and a multi-patient use spacer (Space Pod; Medical Developments International). Children attended the respiratory laboratory twice in 14 days, spacer selection was randomised. Spirometry was performed at baseline and after 200, 400, 800 and 1200μg cumulative doses of salbutamol.Results: To date, 23 children (14 male) aged 9-17 have completed the study. No significant differences in absolute or relative increase in FEV1 from baseline to any dose were found between the two spacers. The maximal BDR at 1200μg was 0.35 (0.02) L (Mean (SEM)) for the Space Pod and 0.33 (0.02) L for the Lite Air. Largest mean difference in device at any dose was 1% (20ml). At the initial visit 16 children had a significant BDR (200ml and 12% increase in FEV1) at 400μg salbutamol, a further 2 at 800μg and 2 at 1200μg.Conclusion: These data suggest that the differences in vitro spacer drug delivery performance may not translate to significant differences in the BDR of asthmatic children. These results suggest disposable spacers may be used in clinical BDR testing of children. The current ATS guidelines for BDR testing may underestimate the presence of a clinically relevant BDR in asthmatic children. ER -