Asthma is a chronic disease of the respiratory tract that is common in all age groups from young children to seniors. The World Health Organization (WHO) estimates that approximately 15 million people are affected by asthma per year and that there are 250,000 asthma deaths annually. Therefore, Asthma is major global health challenge. The increasing asthma prevalence in the Asia Pacific region is linked to increasing air pollution. The prevalence of childhood asthma in Asia is currently around 10-15% and was more than 10 years ago. In Thailand, some 1.4 million children suffer from asthma, especially children under 5 years old, the group unable to use inhalator devices. Thus, they suffer greater asthma exacerbations, 100,000 patients per year, and seek treatment in emergency rooms, 400,000 patients per year. These lead to reduced quality of life, cause children to miss school and an adverse economic impact on families through missing work and travel and medical costs. The mean total, direct and indirect cost per sick child in 2013 was 8,009, 6,723 and 1,285 Baht (USD 258, 216, 41), respectively. This translates into an economic burden of asthmatic children for Thailand of 10,972 million Baht (USD 354 million). Moreover, asthma causes more than 1,000 deaths per year. One key reason for frequent hospital admissions and death is poor asthma control in the community because of children cannot use currently available inhalers; this means little or no medicine gets into the lungs.
The most commonly used drug delivery system for asthmatics is the pressurized metered-dose inhaler (pMDI) which delivers drugs to the diseased lung where they act rapidly. However, for optimal effect, it requires good hand mouth lung coordination which is lacking in young children and older individuals. Therefore, an add-on device called a spacer is used overcome the pMDI limitations. Indeed, the spacer increases lung drug deposition by 30%. However, these devices are mostly imported and cost up to USD30-40 which is not reimbursable by the Thai health system. Based on survey, only 10% of child patients use spacers. They are exclusively used in hospitals in the larger cities and are unavailable to patients in rural areas. Furthermore, we have also found that medical staff are not only unable to teach the pMDI inhaler technique properly but they are also unaware of the usefulness of spacers. Our team has invented a Do-It-Yourself (DIY) spacer using readily available materials such as plastic bottles to make this inexpensive device accessible to all patients. We have also initiated a network of volunteers to disseminate knowledge of how to make these DIY spacers so that patients around the country can afford to use them, control asthma better and, hopefully, save lives.