Real-Life Outcomes for Patients with Asthma Prescribed Spacers for Use with Either Extrafine- or Fine-Particle Inhaled Corticosteroids

Theresa W Guilbert, Gene Colice, Jonathan Grigg, Wim van Aalderen, Richard J Martin, Elliot Israel, Dirkje S Postma, Nicolas Roche, Wanda Phipatanakul, Elizabeth V Hillyer, Jennifer M Evans, Myrna B Dolovich, David B Price (Corresponding Author), Respiratory Effectiveness Group

Research output: Contribution to journalArticlepeer-review

11 Citations (Scopus)


BACKGROUND: Spacers are often used with pressurized metered-dose inhalers (pMDIs) to eliminate the need for coordinating inhalation with actuation.

OBJECTIVE: To investigate the real-life effectiveness of spacers prescribed for use with either extrafine- or fine-particle inhaled corticosteroids (ICSs).

METHODS: This historical matched cohort study examined anonymous medical record data over 2 years (1-year baseline, 1-year outcome) for patients with asthma aged 12 to 80 years initiating ICSs by pMDI with or without prescribed spacer. We compared outcomes for spacer versus no-spacer arms, matched for key baseline and asthma-related characteristics, within 2 ICS cohorts: (1) extrafine-particle ICS (beclomethasone) and (2) fine-particle ICS (fluticasone). Effectiveness end points were compared using conditional regression methods.

RESULTS: Matched spacer and no-spacer arms of the extrafine-particle ICS cohort each included 2090 patients (69% females; median age, 46-47 years) and the 2 arms of the fine-particle ICS cohort each included 444 patients (67% females; median age, 45 years). With extrafine-particle ICS, we observed no significant difference between spacer and no-spacer arms in severe exacerbation rate (primary end point): adjusted rate ratio, 1.01 (95% CI, 0.83-1.23). With fine-particle ICS, the severe exacerbation rate ratio with spacers was 0.77 (0.47-1.25). Oropharyngeal candidiasis incidence was low and similar in spacer and no-spacer arms for both ICS cohorts.

CONCLUSIONS: We found no evidence that prescribed spacer devices are associated with improved asthma outcomes for extrafine- or fine-particle ICS administered by pMDI. These findings challenge long-standing assumptions that spacers should improve pMDI effectiveness and indicate the need for pragmatic trials of spacers in clinical practice.

Original languageEnglish
Pages (from-to)1040-1049.e4
Number of pages14
JournalThe journal of allergy and clinical immunology. In practice
Issue number4
Early online date18 Jan 2017
Publication statusPublished - Jul 2017


  • asthma
  • inhaled corticosteroid
  • IQR
  • interquartile range
  • MMAD
  • mass median aerodynamic diameter
  • pMDI
  • pressurized metered-dose inhaler
  • SABA
  • short-acting β-agonist


Dive into the research topics of 'Real-Life Outcomes for Patients with Asthma Prescribed Spacers for Use with Either Extrafine- or Fine-Particle Inhaled Corticosteroids'. Together they form a unique fingerprint.

Cite this