The expense and lack of availability of spacers for use with metered dose inhalers in asthma prevents their use in developing countries. An effective alternative to a spacer is a 500ml plastic bottle, according to a study of 88 children by Dr Heather Zar and colleagues from the University of Cape Town, South Africa (Lancet 1999;354:979).
A hole in the base of the plastic bottles was made, into which the inhaler was tightly fitted. Some bottle spacers were sealed around the inhaler with glue, while others were left unsealed. Spacers were also constructed from polystyrene cups by making a hole for the inhaler in the bottom and using the cup as a facemask. Sealed bottle spacers gave similar results to conventional spacers but unsealed bottle spacers were less effective. The least successful device was the polystyrene cup. The authors say: "Adaption and use of the bottle as a spacer should form part of asthma education programmes in developing countries".