Disparity between spacer prescribing in secondary and primary care: An Audit

<bold>Introduction</bold> Good inhaler technique is paramount in increasing the ratio of drug transfer into the lower airways rather than the oropharynx. The use of spacers or any valved holding chamber is shown to increase drug delivery into the lower airways and is considered as effective as a nebuliser. BTS and ERS guidelines encourage clinicians to prescribe pMDIs with inhaler devices in patients with asthma and COPD. There is a disparity between spacer prescribing in primary care compared to secondary care. <bold>Method</bold> A prospective audit was conducted across two hospital sites in a large NHS trust. Information was gathered on patients admitted to these hospitals over one month with a pMDI. Patient records were checked for primary care spacer prescription along with prescription of spacer on the hospital drug card. <bold>Results:</bold> Of a total of 153 patients, 65 (45%) had a spacer prescribed in primary care. 6 (9%) of these patients had a spacer prescribed in hospital. A survey conducted in a small junior doctor forum about why this disparity occurred highlighted lack of education around spacer usage and prescribing. <bold>Conclusion:</bold> Spacer prescribing for pMDIs is poor in both primary and secondary care but especially so in secondary care. Junior doctors need education on the benefits of spacer prescribing in hospital. Asthma and COPD specialist nurses should review all exacerbation admissions and encourage spacer prescribing. We suggest that hospitals with electronic prescribing systems should incorporate a joint pMDI and spacer prescription to encourage spacer use.