Healthcare Providers' Prescription Practices for Spacer Devices and Mask Sizes in Pediatric Asthma Care

BACKGROUND: Asthma guidelines recommend that children use a valve-holding chamber or spacer with inhalers for optimal delivery of asthma medications. Spacers with correct-fitting face masks should be used to deliver the full dose of medication. OBJECTIVE: To evaluate healthcare providers' prescription practices regarding spacer devices for children, focusing on factors influencing mask size specification. METHODS: We conducted a cross-sectional survey with pediatric and family medicine providers across 18 Bronx, NY clinics. The survey assessed providers' preferences for prescribing spacers, frequency of mask size specification, barriers to prescribing and possible solutions. Data were analyzed using descriptive statistics, chi-square tests, and multivariable logistic regression. RESULTS: 149 providers participated (response rate: 71.0%). Providers who assessed inhaler-spacer technique during visits were more likely to specify mask sizes than providers who do not assess the technique (54.0% vs 33.3%, p = 0.017). Pediatricians specified mask sizes more often than family providers (52.5% vs. 21.4%, p = 0.003). Providers who frequently saw children with asthma had significantly higher odds of specifying mask sizes (OR = 2.64, 95% CI: 1.20-5.98, p = 0.017), as did those who reported patients bringing spacers to visits (OR = 2.59, 95% CI: 1.26-5.47, p = 0.011). Barriers cited included insurance coverage issues, pharmacies not having spacers with masks in stock, and challenges in ordering spacers via Electronic Health Records. Suggested solutions included having models of spacers in the office and guidelines on what size mask to order. CONCLUSION: Our findings highlight the variability in providers' prescription practices for spacers. Future interventions should target provider education and addressing barriers to optimize asthma care.