Innovative bottle spacers for asthma spread across the country
An innovative approach is set to make a huge impact on treating asthma in South Africa, made more critical during the coronavirus pandemic. Asthma treatment is usually given by an inhaler, but to get medication more effectively to the lungs, a spacer used along with the inhaler, or a nebuliser is required. However nebulisation, a popular therapy in emergency units, aerosolises patients’ secretions which we know increases the spread of coronavirus.
Extraordinary times require extraordinary solutions. The bottle spacer programme, pioneered at the Red Cross War Memorial Children’s Hospital in Cape Town has used modern technology to create a low-cost, recyclable solution to serve the unique needs of our public health service, which requires large numbers of spacers to treat asthma attacks during the upcoming winter months.A young patient demonstrates how the spacer is used
This plastic bottle spacer not only allows the medication to work much more effectively, but also has the added benefit of minimising droplets in the air and ultimately reducing the risk to staff and patients becoming infected with the coronavirus.
When one uses an asthma pump directly in the mouth most of the spray hits the back of the throat and does not go into the lungs. A spacer is a chamber filled with air, with the asthma pump fitting into the back. When you spray the pump first inside the chamber and then breathe this air into one’s lungs, the spray goes into the deepest part of the lungs where it is needed the most.
“Since Prof Heather Zar first pioneered bottle spacers back in the late 90s using a manual burning technique, Red Cross War Memorial Children’s Hospital has been using them. But from just a few hundred units a year, we needed to produce tens of thousands, to facilitate the large-scale use of spacers in the public health service across the country,” Prof Michael Levin, Head of Allergy at Red Cross and CEO of Allergy Foundation South Africa and project lead, explains. The team has tested and evaluated the efficacy of using plastic bottle spacers, demonstrating that they are as effective as commercial spacers.
The new method of production uses a custom blow-mould base with an indentation in the shape of an asthma pump nozzle, produced by Polyoak packaging and Habitat IndustriesThe new bases for the injection moulding machine
“During production when the bottle is blown and the plastic is still soft, air is blasted into the bottle base which creates the inhaler size extrusion. So, after that, the only small manual task is to slice off the end of the indentation leaving a perfect-fit attachment hole for the inhaler. Amazingly, we’ve even been able to include the Allergy Foundation website address on the base of the bottle as a reminder for patients where they can get more information about asthma,” continues Prof Levin.
Prof Andre Van Niekerk, head of the Allergy Society of South Africa says “The bottle spacers will help making the treatment of both acute and chronic asthma much more effective. Inhaled steroids are completely safe, even for people with viral infections and coronavirus, so remember to use your pumps every day to keep asthma well controlled and prevent you having to go to hospital during this time.”
3000 bottle spacers have been distributed to Groote Schuur, Red Cross and Tygerberg hospitals, and a further 10 000 are already available throughout the Western Cape’s public health service via the central medical depot which will be distributed to the province’s various hospitals and clinics in preparation for the projected spike of respiratory infections in the winter months.
The project has been enthusiastically supported by the Provincial Governments of the Western Cape, Gauteng and Kwazulu Natal. The moulds have been couriered to Gauteng and a batch of 20 000 spacers will be produced on the 15th of May and delivered to the University of Pretoria Faculty of Health Sciences where a team of volunteers organized by Profs Robin Green, Izelle Smuts and Ronel Herselman will finalise the processing of the spacers and organize distribution to the Gauteng Medical Supply Depot. Thereafter the moulds will be sent to KZN for another batch to be produced.
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Business Manager, Allergy Foundation South Africa
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