Asthma is a global disease, but its impacts aren’t.
For one thing, it’s linked to a variety of factors, including air pollution, smoking, and insufficient medical care, that are more severe in poorer countries.
The effects can be seen in mortality rates. According to the Global Asthma Network, age-standardized asthma mortality is highest in Fiji, the Philippines, and South Africa. (However, there are data gaps in a number of countries, especially if asthma isn’t recorded as a cause of death.) While asthma deaths are low overall, these are preventable.
One reason people, mainly older adults, are still dying of asthma is that in resource-strapped places, it’s hard to access preventers. So these medical systems are likely to focus on relievers instead. Thus, in low-income countries, according to the Global Asthma Report 2018, “the huge majority of asthma patients are being treated only on an emergency basis.” At that point it may already be too late. One policy implication is that preventive medicines and care should be provided for free or at subsidized rates to affected people who couldn’t otherwise afford them.
But while asthma inhalers themselves are complicated to manufacture, and heavily marketed, one accessory doesn’t need to be costly. In fact, it can be made using commonly found and discarded objects.
This is the spacer, which helps control how much of the medication is being taken into the user’s lungs. A spacer is a long plastic device that attaches to an inhaler on one end and a mouthpiece on the other. The medicine accumulates within the device. Thus the user doesn’t need to inhale deeply, as they would with just an inhaler; just breathing normally does the trick. According to Asthma UK, this allows for more effective use, as the flow of the medicine is slowed and less of it is needed. And because more of the medicine actually reaches the lungs, the likelihood of side effects is reduced. Spacers are recommended for children.
Simple spacers can be made with plastic bottles, Styrofoam cups, plastic baggies, paper, or even toilet paper rolls. This kind of hack is especially useful for non-medical settings or places with little money to spend on medical devices. In the US, a spacer typically retails for around $20. Some research suggests that a DIY version is just as effective as a commercially made one, although this may need to be reevaluated as inhalers become more sophisticated. And other research points to the inconsistency of these unconventional spacer models.
With these caveats in mind, how can you actually turn a .5-litre plastic bottle into a spacer?
The Global Asthma Report 2018 gives the following steps:
“1. Wash the bottle with soap and water and air dry for a minimum of 12 hours to reduce electrostatic charge on the interior plastic.
2. Make a wire mould similar in size and shape to the mouthpiece of the MDI [metered-dose inhaler].
3. Heat the mould and hold in position on the outside of the base of the plastic bottle until the plastic begins to melt (~10 seconds). Rotate the mould 180% and reapply to the bottle until the mould melts through to make a hole.
4. While the bottle is still warm, insert the MDI into the hole to ensure a tight fit between the MDI and bottle spacer. New bottle spacers should be primed initially with 10 puffs of the medicine to reduce electrostatic charge on the walls, which attracts small particles, and thus make more aerosol medicine available for inhalation.”
A simpler version is just to cut an opening into the bottom of a plastic bottle and insert an inhaler, although this is likely to be less effective than the one above, as it would be less securely fitted and would have greater electrostatic charge.