Can an Easi-Breathe spacer be used with Symbicort (budesonide/formoterol)?

Using an Easivent Spacer with Symbicort

Yes, an Easivent spacer can be used with Symbicort (budesonide/formoterol) pressurized metered-dose inhaler (pMDI), and this combination is recommended as it improves drug delivery to the lungs compared to using the inhaler alone.

Benefits of Using a Spacer with Symbicort

Spacer devices significantly improve the delivery of inhaled medications to the lungs, particularly for patients who may have difficulty coordinating inhalation with MDI actuation. The 2024 American Heart Association guidelines strongly recommend using either an inhaler with a spacer or a nebulizer when assisting someone with asthma to use their inhaled bronchodilator medication 1.

Research specifically examining Symbicort pMDI with a spacer (AeroChamber Plus Flow-Vu) demonstrated:

• 68-77% increase in total systemic bioavailability
• 146-173% increase in lung exposure of both budesonide and formoterol 2

These improvements were particularly significant for patients with poor inhalation technique, bringing their medication delivery up to levels comparable to those with good technique using the inhaler without a spacer.

Proper Technique for Using Symbicort with a Spacer

When using Symbicort with a spacer:

1. Shake the inhaler well before use
2. Connect the inhaler to the spacer
3. Exhale completely away from the device
4. Place the mouthpiece in your mouth with a good seal (or use mask if appropriate)
5. Actuate one puff into the spacer
6. Take a slow (3-5 seconds), deep inhalation
7. Hold your breath for 10 seconds if possible
8. Wait before administering a second puff if required 1

Important Considerations

• Timing matters: Minimize delay between actuation and inhalation, as delivered dose decreases with increasing delay time 2
• Cleaning: Rinse plastic spacers monthly with dilute household dishwashing detergent (1:5000 ratio) and allow to air dry 1
• Alternatives: While Symbicort is available as both a pMDI (which can use a spacer) and as a Turbuhaler dry powder inhaler (DPI), only the pMDI version can be used with a spacer 3, 4

Clinical Implications

Using a spacer with Symbicort pMDI offers several advantages:

• Improves lung deposition of medication
• Reduces oropharyngeal deposition and related side effects (e.g., thrush)
• May reduce the potential systemic availability of inhaled corticosteroids with higher oral absorption 1
• Particularly beneficial for patients with poor inhaler technique or coordination issues

Conclusion

The evidence strongly supports using an Easivent spacer with Symbicort pMDI to optimize medication delivery, especially for patients who struggle with proper inhaler technique. This approach aligns with current clinical guidelines that recommend spacer use with metered-dose inhalers to improve therapeutic outcomes in respiratory conditions.