♦ Guilbert TW, et al. J Allergy Clin Immunol
Pract. Jan. 18, 2017, http://bit.ly/2lGjVr3.
Using spacers with pressurized metered-dose inhalers
(pMDIs) to administer inhaled corticosteroids (ICS) was
not associated with better outcomes among adolescents
and adults with asthma, a retrospective study of 4,504
patients in the United Kingdom found.
Asthma patients often have difficulty inhaling the
aerosol from the pMDI at the correct time. Valved
holding chambers (spacers) were invented in the 1980s
to increase the amount of medication that gets into the
lungs. However, the effect of spacers on asthma outcomes
has not been well-studied.
This study used medical record data from patients ages
12-80 years who were diagnosed with asthma and/or
had one or more prescriptions for fine or extra fine particle ICS (beclomethasone dipropionate or fluticasone
propionate). Patients were matched according to ICS
particle type and whether they were prescribed a spacer.
The primary outcome was the number of severe asthma
exacerbations requiring an emergency department visit or inpatient hospitalization or a course of acute oral
corticosteroids after a lower respiratory visit. Secondary
outcomes included acute respiratory events, asthma control and incidence of thrush.
Results showed no significant difference in the rate of
severe exacerbations or acute respiratory events between
the spacer and no-spacer groups regardless of whether
they used a fine or extra fine particle ICS.
Overall asthma control was significantly better in the
no-spacer group, while treatment changes were more
frequent among those using spacers. The incidence of
thrush was low in both groups.
The authors noted that they did not assess whether patients prescribed a spacer actually used it. Also, patients
with poor inhaler technique may have been prescribed
a spacer, which leveled the playing field between the
The authors called for more studies on the benefits of
spacers, especially in children under 12.
“Our findings challenge the intuitive hypothesis that
spacers should improve the effectiveness of pMDIs and
also suggest the need for thorough patient education regarding inhaler use, whether or not a spacer is provided,”
by Carla Kemp • Senior Editor
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Adding healthier food
to concession stand
a winning move
♦ Laroche HH, et al. J Sch Health.
Student satisfaction remained high after
healthier food items were added to a high school
concession stand menu, even among those who
were not health conscious, a new study found.
Local and federal policies to make healthier
foods available at schools often don’t include
concessions at sporting events. Researchers
noted that this sends an inconsistent message
to students about the importance of healthy
eating. Therefore, they teamed up with a high
school booster club on a pilot study to improve
the nutritional content of concession stand offerings without cutting into the club’s profits.
Results of the nutritional makeover showed
the eight new foods that met the U.S. Department of Agriculture Smart Snacks guidelines
made up about 9% of sales revenue, and profit
per game remained the same (Laroche HH, et
al. J Public Health (Oxf). 2015;31:116-124).
This study extended that research by assess-ing how students felt about the menu changes.
Students were surveyed before and after the
menu revamp regarding how important they
thought it was to offer nutritious options and
satisfaction with the variety and taste of food
sold at the concession stand. The post-intervention survey also asked how many times they
bought food during one sports season.
About 300 students completed each survey.
Results of the post-intervention survey showed
students most often bought candy (2.9 purchases) followed by popcorn and nachos (2.5
purchases) and then healthier items such as
grilled chicken sandwiches, soft pretzels and
low-sugar granola bars (at least two times).
Students who said it wasn’t important
to have healthy food on the menu bought
at least one nutritious item as frequently as
health-conscious students (76% vs. 78.7%).
In addition, students who did not care about
healthier options gave higher ratings to the variety of food offered, while health-conscious
youths were more satisfied with food taste.
“Selling healthy foods at concession stands
turns out to be a win-win,” co-author David
Just, Ph.D., of Cornell University, said in a
news release. “Students are more satisfied and
the bottom line improves.”
Spacers not associated with better asthma outcomes
College freshmen struggle to manage ADHD
♦ Schaefer MR, et al. J Adolesc Health. Feb.
2, 2017, http://dx.doi.org/10.1016/j.
Students with attention-deficit/hyperactivity disorder
(ADHD) were unprepared to manage their condition
independently when they went away to college, and their
grades suffered as a result, a study of freshmen at a large
public university revealed.
Research has shown that an estimated 75% of adolescents with chronic diseases such as cancer, diabetes
and asthma do not take their medications as directed.
However, no studies have looked at medication management among adolescents with ADHD as they transition
Study authors used questionnaires and in-depth interviews to determine how well 10 college students with
ADHD managed their medications and barriers they
faced. Participants were in their second semester, were
prescribed oral medication for ADHD and had no other
Students filled out two surveys, and researchers con-
ducted one- to two-hour interviews. Transcripts were
coded by three trained coders, and the following themes
• Students lacked the skills to manage their medication
because their parents refilled prescriptions, sched-
uled doctor’s appointments and reminded them to
take their medicine while they lived at home.
• Students chose not to take their medicine due to side
effects and misconceptions about ADHD and when
medication is necessary.
• After seeing their first semester grades, students re-gretted not taking their medication.
• Peers frequently pressured students to share their
• Students wanted social support from upperclassmen
The authors provided a checklist in the article that
families and clinicians can use starting when youths are
12-14 years to prepare them to manage their medication. They also suggested health care providers educate
patients on the importance of taking medication consistently and possible consequences of sharing drugs.
A toolkit to help groups make healthy changes
to concession stand menus is available at http://
Results of a recent study showed no significant difference in the rate of severe asthma exacerbations
or acute respiratory events in patients who used a
spacer with their metered-dose inhaler compared to
those who did not use a spacer.