Helping young children with asthma

A new era in spacer masks that whistle while they work

For too long, many children learning to manage their asthma have been taught using outdated ‘negative reinforcement’ methods – that’s the claim from the managing director of a UK-based medical device manufacturer.

Mark Sanders of Clement Clarke International (CCI) will be using an initial poster presentation at the European Respiratory Society International Congress (ERS) - being held on 3 September - to highlight the advantages of a new type of facemask, specially designed for young children who are learning the essential breathing techniques that allow them to receive the correct amount of medication when using a spacer.

Over the past 30 years children have been taught that a whistle sound indicates that breathing technique is poor - too fast - and therefore medication is not being delivered effectively.

However, the team from Clement Clarke has developed a new mask that guides correct breathing technique and facilitates better fitting as part of the Able Spacer Pack for smaller children with smaller faces.

However, we recognised early on that existing spacer whistles were negative reinforcement alerts and created a great deal of confusion when what was really needed was the opposite

For the first time, the updated Able Spacer will see a whistle embedded into the small mask that sounds when the correct technique has been mastered and the fit is correct. From September there will be the first-ever asthma face mask of its type available on prescription – at no extra cost to the NHS.

Not only will the whistle reassure parents that the mask is a good fit and therefore medication is being delivered, but it will also be the first prescription respiratory device with a free ‘gamification’ App, developed by Dr Tariq Aslam, founder of University of Manchester spin-out, Clin-e-Cal, in response to his son Rafi’s problems with accepting a spacer.

The app helps children to accept having a mask on their face by using a fun, animated game as a free download on both i-phone and android devices.

The concept of the Rafi-Tone App is simple – the whistle sound emitted by the mask when the young user is breathing with the spacer correctly is capable of driving the Rafi robot through a series of challenges as it fights off the attacking ‘baddies’. R

The gadget behind the innovation is a precision plastic reed that is embedded in the small facemask, which emits a tone at a specific frequency as the user inhales medication. It originated in Clement Clarke’s Flo-Tone device.

Sanders said: “Originally we designed the Flo-Tone as a training tool to help people to use their inhalers properly because poor inhaler technique is a widespread problem that limits the benefit people should get from their medication.

“However, we recognised early on that existing spacer whistles were negative reinforcement alerts and created a great deal of confusion when what was really needed was the opposite.

“So we constructed mouthpieces, and now masks ,that could work with a precision reed, engineered so that the whistle went off at a certain flow rate.

“The whistle became the guiding signal to activate the inhaler, with the duration of the sound giving a clue to how long and deep the inhalation was.

“For the mask, hearing the whistle is also confirmation that it is properly fitted without leaks, which is not always easy to establish when the young patient is reluctant to accept a face mask.”

He added: “The safety of children with asthma is absolutely paramount and we are passionate about bringing novel designs to market to ensure that all young people can receive their medication in the best, quickest and easiest way possible.

“Life-saving asthma medications have been available since the 1970s, but unless they are delivered effectively to patients in need, we will continue to see instances of young people becoming breathless, frightened and requiring emergency services.”

With researchers and respiratory experts working collaboratively with the team at Clement Clarke, it has been possible to programme an app that gives us a very easy way of making spacer use more fun

The new research to be presented at the ERS involved 24 healthy volunteers with an average age of five-and-a-half years and will pave the way for further clinical studies.

Of this group, 16 children were able to generate the audible whistle, with just four (aged between 18 months and three years) unable to make an audible sound.

All the children over the age of three used the mask successfully although the toddlers required additional coaching.

Respiratory paediatrician, Dr Clare Murray, from the University of Manchester, who has been involved with the development of Rafi-Tone and the new Able Spacer pack, said: “From the outset I thought it was a great idea because we don’t really have any way of using incentive devices with spacers.

“Some children just take to it, but there’s a number, particularly the little ones, who either get scared or just are bored by it and therefore simply won’t do it. So I thought having something that would entertain them whilst potentially improving their inhaler technique at the same time would be an interesting idea

“With researchers and respiratory experts working collaboratively with the team at Clement Clarke, it has been possible to programme an app that gives us a very easy way of making spacer use more fun.”

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