PT - JOURNAL ARTICLE AU - Aditya Agrawal AU - Girija Nair AU - Abhay Uppe AU - Unni Baby TI - Holding chamber (Spacer) - A potential harbor of pathogenic bacteria DP - 2014 Sep 01 TA - European Respiratory Journal PG - P914 VI - 44 IP - Suppl 58 4099 - http://erj.ersjournals.com/content/44/Suppl_58/P914.short 4100 - http://erj.ersjournals.com/content/44/Suppl_58/P914.full SO - Eur Respir J2014 Sep 01; 44 AB - Introduction: The microbiome of a lung in a patient with obstructive airway is hitherto not defined. Conventional bacterial cultures have always shown that the lower respiratory tract is sterile. Potentially pathogenic bacteria when inhaled in a plume of inhaled medication, could infect the airways and cause an infective exacerbation of airway diseases.Aim: To identify bacterial species growing on the inside of a holding chamber.Methods: 52 patients with chronic stable obstructive airway disease using a metered dose inhaler with a spacer, attending our outpatient clinic were recruited. With all aseptic precautions a swab was taken and gram staining, microscopy and plate culture were performed.RESULTS: The surfaces of 59.61% (31/52) spacers were sterile. 28.84% (15/52) had growth of the environmentally ubiquitous micrococci on the surface. 5.77% (3/52) had growth of Staphylococcus aureus of which 1 was Methicillin Resistant S. aureus (MRSA). Pseudomonas aeroginosa, Escherichia coli and Acinetobater were found on 1.9% (1/52) devices.Conclusion: Most spacer surface are sterile or have presence of non-pathogenic micrococci. These potentially pathogenic bacteria are not a part of the microbiome in normal healthy individuals less so in those with airway diseases. Inhalation of these bacteria increases risk of infective exacerbation. Each exacerbation permanently reduces lung functions. Prevention of infections will limit loss of airway function and achieve better control of the disease.Hence, we propose frequent cleansing, minimal handling, use of alcohol wipes to clean the inner surface of a spacer at least once a week and frequent replacement of the device.