What happens if a patient using Seretide (fluticasone propionate/salmeterol) Inhaler doesn't wash the spacer at all?

Failure to Clean a Spacer Used with Seretide Inhaler Can Lead to Infection Risk and Reduced Medication Efficacy

Not cleaning a spacer device used with Seretide (fluticasone propionate/salmeterol) inhaler can lead to microbial contamination, potential respiratory infections, and reduced medication delivery effectiveness, which may worsen asthma control and outcomes. 1

Risks of Not Cleaning a Spacer

Infection Risk

• Dirty or moist spacers can harbor bacteria and fungi that may cause respiratory infections 1
• Microbial growth in spacers can potentially introduce pathogens directly into the airways during medication administration
• While not all uncleaned spacers show contamination, the risk increases with prolonged lack of cleaning 2

Reduced Medication Efficacy

• Medication residue can build up on the walls of the spacer, reducing the amount of medication that reaches the lungs
• Drug deposits inside the spacer can affect the aerosol properties of subsequently delivered doses
• Proper cleaning helps maintain optimal medication delivery and therapeutic effect 3

Mechanical Issues

• Medication residue can cause valves to stick or malfunction
• Reduced airflow through the spacer due to buildup can affect proper medication delivery
• Visual inspection may become difficult through cloudy or dirty spacer walls

Proper Spacer Maintenance Protocol

According to British Thoracic Society guidelines, spacers should be cleaned as follows 1:

1. Frequency: At minimum, clean once daily when in regular use
2. Method:
   • Wash in warm water with a little mild detergent
   • Rinse thoroughly
   • Allow to air dry completely before next use
   • Do not wipe dry as this can cause static electricity that affects medication delivery
3. Replacement: Replace spacers every 3-4 months with regular use 1

Impact on Seretide Effectiveness

Seretide contains two active medications that require proper delivery:

1. Fluticasone propionate (corticosteroid):

   • Reduces inflammation in the airways
   • Poor delivery may lead to inadequate control of underlying inflammation

2. Salmeterol (long-acting beta-agonist):

   • Provides bronchodilation for symptom control
   • Inadequate delivery may result in insufficient symptom relief

Using a spacer with Seretide significantly improves lung deposition of medication and reduces oropharyngeal deposition 3. However, these benefits are compromised when the spacer is not properly maintained.

Warning Signs of Spacer Problems

Patients should be alert to these indicators that their spacer needs cleaning or replacement:

• Visible residue or film inside the spacer
• Medication seems less effective than usual
• Spacer valves not moving freely
• Increased asthma symptoms despite regular medication use
• Spacer appears cloudy or discolored

Clinical Recommendation

For optimal asthma management with Seretide:

1. Clean plastic spacers monthly with dilute household dishwashing detergent and allow to air dry 3
2. Rinse mouth after using Seretide to reduce systemic absorption of corticosteroids 4
3. Replace spacer devices according to manufacturer recommendations (typically every 3-4 months with regular use)
4. Always use the spacer with proper technique to maximize medication delivery 1

By maintaining proper spacer hygiene, patients can ensure optimal medication delivery, reduce infection risk, and maintain better asthma control.