Hi all. I have spent several days now researching and reading on this issue. Thank you AboveAll for a great question that has rattled around in my brain but which I never really sought to resolve.
My conclusion, first of all, at this point is that I want a Pari Vortex. It can be disinfected.
What I've discovered is that the initial problem, which spacers (also known as valved holding chambers) were designed to resolve, was that most people, adults as well as children, do not use the metered dose inhalers, by themselves without spacers (MDI's) efficiently. Most of the medication wound up at the back of the throat or in the mouth, rather than in the lungs. Good timing and technique was a problem that the vast majority of people experienced, whether they were aware of it or not. It was too difficult to breathe in at the precise moment that the inhaler was depressed - so the medication hit the mouth or throat before a breath was taken, and little medication made it into the lungs.
Spacers allowed the sprayed medication to be held in a chamber until a breath was taken. So the medication finally made it into the lungs, rather than the mouth or throat. Unfortunately they then discovered that the inside of the chamber held an electrostatic charge which attracted the medication particles and adhered them to the walls of the spacer. So, again, a significant portion of the medication did not make it into the lungs - or the mouth or the throat for that matter. Instead it coated the spacer chamber, as Stephen has described. I found several older studies designed to determine how to eliminate the electrostatic charge. One of the principal findings seemed to be that washing in detergent and water eliminated the charge for anywhere from 24 hours to 7 days, depending on which paper you read. They also found that drying it with a paper towel was a bad idea, because that restored the charge. That's all fine and good, but if I'm only allowed to wash with soap and water, how do you disinfect?
Today, we see spacers proclaiming that they are anti static or non electrostatic to solve the problem. The Aerochamber Plus is made of "anti-static" material. The Pari Vortex says it has an antistatic metallic chamber. The OptiChamber we have is no longer sold, but the most recent version also claims to be made of antistatic material. All of them recommend cleaning with detergent and warm water. But that doesn't make me happy. Now, I do understand that they are generally classified as "non-critical" appliances that require only a low level of disinfection according to the CFF Infection Control Guidelines. And I suppose washing in warm water and detergent fits that bill. And I also assume that's just fine for the average non-CFer. But I really want to disinfect the thing. I've seen my little guy drop his on the dog's bed before. I've also seen him step on it, bite it, and grab it with unwashed hands inside the rim. And I have been duly trained to be extremely cautious of contaminants of all kinds. Despite the fact that I'm not piercing his skin with it, he is breathing it in. And isn't that how the vast majority of infections that cause serious issues for CFer's are introduced into their lungs? Through either the nasal or mouth passages? I want to disinfect it.
The Aerochamber says outright that boiling would destroy the appliance. The Optichamber is silent on the issue as far as I can tell. I'm not sure if I missed it the first time through, but if you dig into the additional materials on the Pari site, the Vortex can be disinfected and even sterilized in a hospital setting. Here's the link:
More detailed instructions are here:
It says you can either steam it (but not in a microwave since it has a metal chamber) or boil it in a pot for at least 5 minutes, making sure all the parts are submerged in the pot but not touching the heated bottom. Sounds good to me. Thank you Pari.
If anyone is aware of another spacer that contains instructions for disinfection, please sing out!
Apparently there are different “models” of the AeroChamber Plus.
The "adult" model, which is the only one I was aware of, does not have any type of mouth covering. There is only a non-removable mouthpiece similar to what a nebulizer has.
To use it, I was instructed to take one long slow inhalation breath as the inhaler is depressed; then hold your breth for as long as it’s comfortable. As I've previously indicated, there is a whistle that sounds if the inhalation is too fast.
After using the AeroChamber for a while, a noticeable white power becomes deposited on the inner surface of the tube.
It was explained to me that a major reason to use the AeroChamber was to reduce the amount of this powder that’s inhaled. The powder is a byproduct of the propellant used in measured dose inhalers.. A static charge on the AeroChamber's plastic tube attracts this powder and reduces the amount inhaled. That why I use it whenever I'm at home.