title: [Critical evaluation of inhalation spacer devices available in France].
abstract: OBJECTIVE
  To identify the spacer devices sold in France and to provide a critical evaluation in the light of the published data.
  
  
  METHODS
  We contacted the pharmaceutical companies, manufacturers and distributors of each spacer in order to obtain their technical parameters and the results of any in vitro or in vivo studies. A review of the literature via PubMed completed the first set of data. We were interested in the quantity of fine particles (less than 5 μm diameter) obtained with a cascade impactor at paediatric flow rates, for all inhaled drugs available in France.
  
  
  RESULTS
  Eleven spacer devices were available in 2013 in France (Ablespacer®, Aerochamber Plus®, Babyhaler®, VHC Arrow®, L'Espace®, Funhaler®, Inhaler®, Itinhaler®, OptiChamber Diamond®, Tipshaler® and Vortex®), but three are no longer manufactured (Babyhaler®, Funhaler® and Inhaler®). All were small volume spacers, sold with facial masks of several different sizes. Four were antistatic (Aerochamber Plus®, Intinhaler®, OptiChamber Diamond® and Vortex®). Only salbutamol was tested with all the devices. Inhaled corticosteroids were tested with some and combinations were studied only with Ablespacer®, Aerochamber Plus®, Itinhaler®, and Vortex®. The results were difficult to interpret because the studies were conducted with very different protocols. The only clinical studies were conducted with Aerochamber Plus®, L'Espace® and Vortex®.
  
  
  CONCLUSIONS
  There was a great disparity between commercialized spacer devices in terms of the available data describing their in vitro performance.
authors.affiliation: Unité de pneumologie pédiatrique, CHU Timone-Enfants, AP-HM, 13000 Marseille, France.
authors.forename: E
authors.initials: E
authors.lastname: Gachelin
authors.affiliation: DTF-Aerodrug, faculté de médecine, 37032 Tours, France; Inserm U1100/EA6305, centre d'étude des pathologies respiratoires, faculté de médecine, université François-Rabelais, 37032 Tours, France.
authors.forename: L
authors.initials: L
authors.lastname: Vecellio
authors.affiliation: Unité de pneumologie pédiatrique, CHU Timone-Enfants, AP-HM, 13000 Marseille, France. Electronic address: jean-christophe.dubus@ap-hm.fr.
authors.forename: J-C
authors.initials: JC
authors.lastname: Dubus
mesh_terms: D000280:Administration, Inhalation; D001993:Bronchodilator Agents / Q000008:administration & dosage; D003132:Commerce; D004867:Equipment Design / Q000191:economics / Q000592:standards; D005602:France; D006801:Humans; D036503:Inhalation Spacers / Q000191:economics / Q000592:standards* / Q000706:statistics & numerical data; D036501:Metered Dose Inhalers / Q000191:economics / Q000592:standards; D009330:Nebulizers and Vaporizers / Q000592:standards
chemical_list: D001993:Bronchodilator Agents
keywords: Aérosol médicamenteux; Chambre d’inhalation; Inhaled treatments; Medical aerosols; Spacer; Traitements inhalés