Asthma and Medication Administration Practices in Children: An Exploratory Study on Bacterial Colonization of Inhaler Spacer Devices

Abstract

Introduction: Asthma is one of the most common chronic respiratory diseases in children, and the use of metered dose inhalers (MDIs) with spacers is central to its management. However, these spacer devices, if not cleaned regularly, may become contaminated with bacteria that can worsen asthma symptoms or lead to respiratory infections. This study aimed to evaluate the level of bacterial contamination in MDI spacer devices used by children with asthma and to explore how cleaning habits influence this contamination and associated health outcomes. Methods: We conducted a hospital-based cross-sectional study involving 200 children with asthma who had been using MDI spacers for at least three months. Swabs were collected from the inner surfaces of their spacer devices and cultured on standard media. Bacterial colonies were identified using Gram staining and biochemical tests. Contamination levels were classified based on colony-forming unit (CFU) counts. Associations between contamination, cleaning methods, and hospital admissions were analyzed using appropriate statistical tools. Results: Out of 200 devices, 70 (35%) showed bacterial growth. While many cultures grew Micrococcus spp., potentially harmful bacteria such as E. coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Staphylococcus aureus were also found. Children whose devices were cleaned after every use had significantly fewer hospital admissions than those whose devices were only cleaned occasionally or never. Despite receiving cleaning instructions, most caregivers did not follow proper cleaning routines. Conclusion: The study reveals that a substantial number of pediatric asthma spacer devices are contaminated with bacteria, including pathogenic strains, largely due to inconsistent cleaning practices. These findings emphasize the need for better caregiver education and standardized spacer hygiene protocols to reduce infection risk and enhance asthma control in children.