Plastic bottles as spacers for a pressurized metered-dose inhaler: In vitro characteristics

Homemade spacer devices are commonly used by children with asthma to improve aerosol deposition from pressurized metered dose inhalers (pMDI); however, the efficacy and efficiency of these devices are not fully characterized. We determined the quality of fine particle fraction (<4.7 um) and ultrafine particle fraction (<3.3 um) of three bottles (from 280 ml to 500 ml) commonly used as spacers in Trinidad and Tobago and compared their performance to the commercially available valved holding chamber (OpT) and pMDI. These data were obtained in vitro using a cascade impactor. All 3 bottles and OpT were similar (p>0.05) in reducing the amount of albuterol emitted as large particles (>4.7 um) to less than 10 ug. The diffreent sized bottles (from 280 ml to 500 ml) produced identical quantities of albuterol in the fine particle and ultrafine particle ranges (p>0.05). All of the sample bottle spacers emitted a higher amount (p<0.002) of fine and ultrafine particles than the OpT and pMDI alone. The OpT resulted in a significantly higher fraction of fine particles (p<0.05) and greater quantity of drug (<0.05) in the ultrafine range as compared to MDI only. The sizes of particles obtained from the bottle spacers are those that have a high probability of reaching the lower airway; however, the clinical relevance of these findings remains to be determined. (AU)

An evaluation of the Jamaica Drug for the Elderly programme in Kingston and St. Andrew

The presence of chronic diseases is accompanied by the threat of complications that can be averted if the elderly can obtain the necessary health care. In 1996, the government of Jamaica launched the Jamaica Drug for the Elderly Programme (JADEP) to assist persons 60 years and over with any six chronic diseases, in the purchase of medication. The study aims to evaluate public attitude toward and participation in the programme. A cross-sectional study was conducted in randomly selected pharmacies in Kingston and St. Andrew among 94 elderly persons with certain chronic diseases and 9 providers of JADEP. All elderly persons who entered the selected pharmacy, fulfilled the criteria and who consented to be interviewed were included in the study as was the main pharmacist for that location. A focus group discussion with ten persons helped to eludiate information already obtained. The study revealed that while most elderly persons had neither a positive nor negative attitude towards the programme, the level of registration was not high (52 percent, n=94). Among JADEP participants many (67.4 percent or 29/43) were unable to obtain all their medication at one time due to cost constraints. Both providers and the elderly raised concerns about the limited range of drugs available which was the reason commonly cited for not being able to use the benefit card. The study showed that the extent to which the programme was able to assist the elderly was dependent on their awareness of how the programme functioned and the availability of their medication. The service is a necessary one and its failure would have public health implications as chronic illnesses that are not well managed will increase the health burden of the population and overall health care costs. It is recommended that the range and quantity of drugs that can be prescribed for the particular chronic conditions be re-examined.(Au)