INTRODUCTION

The use of inhalation chambers has increased over recent years, and the time is right to revise the indications and assess the effectiveness of this and other systems used to administer medicines in the treatment of infantile asthma.

AIMS

Analyse the scientific evidence concerning the therapeutic effectiveness of different types of aerosoltherapy in children with asthma and in particular, space chambers, both in long-term treatment (chronic, long-term or disease modifier) and in emergency treatment (severe, symptomatic) in children of different ages.

Determine the prescription and use of inhalation chambers in asthmatic children in the Autonomous Basque Community, as well as the causes that explain their use.

MATERIAL AND METHODS

• Systematic revision of the evidence
• Survey among paediatricians in the Autonomous Basque Community
• Analysis of the prescription of inhalation chambers

CONCLUSIONS

In the light of the scientific evidence, the following conclusions may be drawn:

• The use of inhalation chambers together with a pressurised aerosol is one way of administering inhaled drugs which has been seen to be efficient in the treatment of children with infantile asthma.
• Compared with the use of inhalers, the use of inhalation chambers together with a pressurised aerosol is an effective method in the treatment of asthmatic crises with beta adrenergics and which in general are preferable to inhalers due to their ease of use and cost.
• There is no reliable scientific evidence to draw the conclusion that the administration of drugs inhaled by means of inhalation chambers together with a pressurised aerosol is a more or less clinically efficient method than the administration of these drugs by means of a pressurised aerosol alone or by means of dry powder dispensing devices.
• There is no reliable scientific evidence to be able to conclude that one specific model of chamber is more effective than another.
• No reliable scientific evidence has been found to determine whether chambers of a size under 750 ml are more effective than the larger ones in young children.

There is a need to carry out specific surveys in order to analyse the effectiveness of each combination between specific aerosols and chambers and for studies to be made to compare these combinations.

With regard to surveys of knowledge on this subject, these show that one in every three paediatricians who responded to the survey prescribes pressurised aerosols with space chambers for children of over 7 years of age when, unless the child shows problems of motor co-ordination, they should prescribe dry powder dispensers that are more efficient with smaller doses.

The current cost refunding system for several inhalation chambers represents a major added cost for family members who have to follow lengthy procedures to obtain these, and a major use of public resources due to the fact that Basque Government Inspectors must intervene in order to resolve every individual petition. I is also seen that there are no unified criteria in the Inspections of different departments with regard to the criteria that justify the refunding of the cost in chambers not financed by the Social Security (S.S.).

RECOMMENDATIONS

In the light of existing surveys and the recommendations of the different scientific societies, it is considered reasonable make the following recommendations:

• Use paediatric chambers between the ages of 0-4.
• Use adult-type chambers for 3-4 years and above.
• Use dry powder dispensers for children of over 6-7.

Likewise, the preparation and dissemination of explanatory material on the approach to infantile asthma and the role of the different space chambers in this, is considered to be of great interest.

Due to the fact that an increase has been detected in the use of inhalation chambers in pathologies other than infantile asthma it is necessary to clarify whether inhalation chambers (those financed by the S.S. And not) are effective in the treatment of illnesses other than infantile asthma, and whether these should be paid for by the public health system.

It is recommended that the Health Department should consider the possibilities, advantages and disadvantages of changing the cost refunding system for chambers not financed at this time by the S.S., as well as the harmonisation the criteria for provincial inspections with regard to criteria that justify refunding the cost for chambers not financed by the S.S.

It is also recommended that if suitability criteria are to be established for prescription and financing, this process should be done with the participation of the professional and scientific societies involved.