We thank Dr Carter for his interest in our study and appreciate his comments. Dr Carter believes that the use of an MDI-S for administration of medications to infants and toddlers is controversial. We disagree; there are six published studies demonstrating effective administration of bronchodilators to infants via MDI-S.1-6
Dr Carter objects to our spacer's small volume and the presence of a one-way valve. Larger-volume spacers have less drug impacted on the wall of the spacer with actuation, thereby increasing drug availability. A smaller-volume spacer will have less total drug available owing to impaction, but the concentration of drug in the spacer will be greater. In patients with small tidal volumes, the benefit of increased drug concentration found in smaller-volume spacers becomes relatively more important than the amount of total drug available in larger spacers.7 In other words, although there may be more drug available in
Hickey RW, Gochman RF, Chande V, Davis HW. Albuterol Administered by Metered-Dose Inhaler and Spacer to Young Children With Wheezing-Reply. Arch Pediatr Adolesc Med. 1994;148(12):1353–1354. doi:10.1001/archpedi.1994.02170120114027
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