A message to MNAAP members from Mary Meyer, RN, NBC-HWC, clinical advisor of the Minnesota Department of Health Asthma Program; Jill Heins-Nesvold, MS, national senior director of Health Systems Improvement at the American Lung Association; and Tara Cliff, president of the School Nurse Organization of Minnesota:
It has been widely accepted that it is best practice to use a spacer or valved-holding chamber with a metered-dose asthma inhaler. The coordination needed for inhaling the medication at incredible speeds (up to 70mph) is difficult to achieve for most people. Spacers and valved-holding chambers optimize delivery of medication by increasing the amount of medication that reaches the lungs and make medication delivery more effective and very efficient.
The Minnesota Department of Health and our partners have fielded a plethora of feedback that spacers and valved-holding chambers are not routinely prescribed and/or dispensed alongside inhalers. School nurses report students regularly presenting with their inhalers but no spacer or valved-holding chamber and local health departments report home visits that uncover a lack of valved-holding chambers or spacers.
There are financial and logistical barriers for families to secure spacers and/or valved-holding chambers without the help of providers. Spacers and valved-holding chambers are considered medical device equipment so that without a prescription, they must be secured through a DME company and may not be covered by insurance.
Providers play a crucial role in ensuring every child who should be using a spacer or valved-holding chamber and has one. Writing a prescription for a spacer/valved-holding chamber alongside every inhaler (when indicated) will improve the benefit of using the medication (relief of symptoms). This action will help to avoid additional steps to get students what is needed to improve their asthma – steps that families often cannot or do not take.