By Anne Harding

NEW YORK (Reuters Health) - Homemade devices to help children take inhaled asthma medication more easily may be just as effective as the commercial versions, according to a new review of all existing studies comparing them.

But the commercial type should remain the first choice if they are available, the study's authors say, given the limitations of research to date.

Called spacers, the devices make it easier for children to coordinate inhalation with the release of beta 2-agonist medication, which is used to treat asthma attacks. Spacers also allow for more of the drug to be delivered to the lungs and less to wind up in the mouth and throat, thus reducing side effects.

But commercially produced spacers can cost up to $45 and are often not covered by insurance, one of the review's authors, Dr. Carlos Rodriguez of Clinica Colsanitas in Bogota, Colombia, told Reuters Health via e-mail. So in the developing world, spacers made from materials ranging from plastic bottles or plastic zip-up bags to paper and polystyrene cups are widely used, he added.

Writing for the Cochrane Collaboration, a non-profit group that publishes systematic reviews of different types of therapy, Rodriguez and his team searched the medical literature and found six studies including 658 patients that compared home-made spacers with commercial spacers for treating asthma attacks or lower airway obstruction. The studies were conducted in India, South Africa, Brazil and the Philippines.

The researchers found no difference in the effectiveness of commercial versus homemade spacers. But because there were relatively few studies, including a small number of events in which patients actually used the devices, "we consider that the results of this review should be interpreted with caution," Rodriguez said. "They need confirmation through further, larger trials. In the meanwhile, selection of the spacer device for an individual patient should begin with a commercial spacer, with home-made spacers being used if a commercial device is not available."

SOURCE: The Cochrane Library, April 15, 2008.

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