vhc spacer for inhaler cvs

Valved holding chambers and spacers are very similar devices; both are plastic tubes that attach to your metered-dose inhaler and are recommended for adults and children. Unique stepped mouthpiece accommodates smaller mouths OptiChamber's mouthpiece design helps patients transition from pediatric facemasks to mouthpiece. Professional guidelines recommend that pMDIs be used with a spacer or valved holding chamber (VHC) but actual use is lagging, with estimates varying from 10% in the UK in 1990 to 46% in Canada in 2008. Am J Respir Crit Care Med 2020;201:A5889. Works like a chatm, This is for my son to keep at school for asthma flare ups. Spray one puff of medicine and inhale slowly over about 35 seconds, sealing your mouth tightly around the inhaler so air cannot escape. Talk with your doctor about how often your spacer should be cleaned. Our website services, content, and products are for informational purposes only. The health information described on this site is for educational purposes only and is not intended to substitute for discussions with a healthcare provider. The spacers are lightweight and portable to treat asthma symptoms by conveniently attaching to a metered-dose inhaler. The inhaled medicine goes into the spacer tube first. Asthma can be mild or severe. Amazon.com: Vhc Spacer For Inhaler 1-48 of 62 results for "vhc spacer for inhaler" Price and other details may vary based on product size and color. Once you have the right equipment, just follow these step-by-step instructions. Even though a spacer makes it a little easier to use your inhaler, you still have to focus on breathing in once the medication is released. Our service is free and we are here to help you. A spacer is an attachment that fits onto the end of your inhaler. In addition, feedback mechanisms, such as a whistle that sounds if a patient inhales too quickly, help insure correct breathing techniques. Spacers/VHCs are made of either polycarbonate plastics or metal. An inhaler works most effectively when it delivers the medication in a slow, controlled way. Exhale as much air as possible from your lungs. Last medically reviewed on November 10, 2017, If you have an asthma attack and your rescue inhaler isnt available, there are some ways to ease the symptoms until youre able to get your inhaler, There are a variety of over-the-counter inhaler options for mild asthma symptoms. F ollowing on the heels of more widespread cannabis legalization has come a multitude of ways to consume the versatile plant, like edibles, concentrates, dry herb vaporizers, and many more.One such innovation is the advent of the cannabis inhaler. "Poor inhaler technique leads to poor asthma control, increased risk of exacerbations and increased adverse effects. Thank you for your interest in spreading the word on European Respiratory Society . Just like the one I got from doctor. "While some HFA inhalers may sell for as much as $60 for certain brands, our $9 ReliOn Ventolin HFA inhaler will . Its a clear tube that fits between the inhaler holding the medication and your mouthpiece. Or is CVS just trying to sell more product? Common side effects of FLOVENT DISKUS include: upper respiratory tract infection. A spacer is used for a type of inhaler known as a metered dose inhaler. Put the spacer mouthpiece between your teeth and seal your lips around the mouthpiece. Asthma inhalers: Which ones right for you? The spacer may have a one-way valve that holds the medicine in the chamber before it is inhaled. Agitate gently. Slows down the aerosol cloud as it emerges from the pMDI Reduces impact of hand-breath (activation-inhalation) coordination problems Longer propellant evaporation time reduces particle size (increases respirable fine-particle fraction) and improves lung deposition Filters out larger aerosol particles Reduces oropharyngeal impaction/deposition and local side effects (inhaled corticosteroids) Reduces fraction of swallowed drug, gastrointestinal absorption, systemic bioavailability and thus extrapulmonary unwanted effects (-adrenergic agonists) VHCs can be used with tidal breathing, administered by a caregiver For the very young (using a face mask) and any patient where coordination is a challenge During acute exacerbations (replacing nebulizers), Require regular cleaning Large-volume spacer/VHC devices are more bulky, less portable Electrostatic charge may reduce the respirable aerosol fraction More expensive (but may save medication). Debra Rose Wilson, Ph.D., MSN, R.N., IBCLC, AHN-BC, CHT, Your Guide to Having Allergies and Asthma. I will shop here again., The product is a good one to be used by my spouse. You want as much medication going down your airways and into your lungs as possible. Spacers/VHCs made of conducting, antistatic material may be rinsed both on the outside and inside before air drying overnight. One of the options available to treat these is an inhaler, Many people ask how, why, and when to use nebulizers, how to take care of them, and how they differ from inhalers. This was so much better than spending $150 for two spacers through the pharmacy. The clinical sequelae, if any, are not clear, and the principle of thoroughly cleaning the spacer/VHC after each and every use is neither practised nor recommended in manufacturers' instructions. The aero chanber brand is a good size, unlike another brand she used that was bigger in diameter., I would recommend this product to anyone with a child diagnosed with asthma. The PARI Vortex is an affordable valved holding chamber that minimizes the technique and coordination needed for effective inhaler treatments. New nonconducting spacers/VHCs should therefore be washed before their first use. Breathe in and out through the chamber for 2-3 breaths keeping lips sealed around the chamber mouthpiece. The most important aspect of inhaler spacer care is keeping it clean. Is the ketogenic diet right for autoimmune conditions? An anti-static valved holding chamber (aVHC) is commonly known as a spacer, a device used with your inhalers to ensure the medication gets to your lungs and not in your mouth or back of your throat. If you hear the whistle, reduce the rate of inspiratory flow until the whistle disappears; this is the correct inspiratory flow. See additional information. We avoid using tertiary references. It Fit my inhaler. $17.99 (2 used & new offers) Inhaler Spacer for Adults, Aerochamber Spacer with Comfortable Adult Face Mask, Spacer for Inhaler & MDI, Improves Pump & Aeroflow Chamber Delivery for Asthma, Blue 1 Count (Pack of 1) 64 $2299 ($22.99/Count) FREE delivery Thu, Apr 20 on $25 of items shipped by Amazon Or fastest delivery Mon, Apr 17 More Buying Choices Nebulizers: What they are and how to use them. A few of these findings are highlighted here: Volume is among several considerations when choosing a spacer/VHC because it determines the number of breaths needed to empty it. Product as advertised. A few of these findings are highlighted here: Professional guidelines recommend that pMDIs be used with a spacer or valved holding chamber (VHC) but actual use is lagging, with estimates varying from 10% in the UK in 1990 to 46% in Canada in 2008. Breathing Treatments: Which One Works Best? MNT is the registered trade mark of Healthline Media. Do NOT rinse. Ordinary inhalers require you to press a button that releases the medication, and then take a deep breath immediately. Easy of usage., Helps me get more of my medicine. Further research is necessary to define more precisely the clinical benefits of the use of spacers/VHCs in the real world, which will in turn allow estimation of their cost effectiveness. You should also clean your spacer before using it the first time. There are different types of spacers - small, medium and large volume holding chambers. However, it is commonly recognized that these devices are often used incorrectly or suboptimally, which may affect efficacy, safety and patient compliance. The authors recommend using these devices for all patients, and call on healthcare professionals to teach patients how to use inhalers and spacers properly. If you cannot hold your breath, keep your lips tight on the mouthpiece and breathe 2-3 times with your lips sealed on the chamber. But youll need to do so at least after every few uses, or if the inhaler hasnt been used for a day or two. Let's join together to end the youth vaping epidemic by supporting parents, schools and students. European Respiratory Journal 2019 54:PA4229. Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional. The spacer aspect of this item creates space between the inhaler and the user's mouth. Using a spacer device can be cumbersome. Inhaler Spacer for Adults, Aerochamber Spacer with Comfortable Adult Face Mask, Spacer for Inhaler & MDI, Improves Pump & Aeroflow Chamber Delivery for Asthma, Blue 1 Count (Pack of 1) 64 $2299 ($22.99/Count) FREE delivery Wed, Apr 19 on $25 of items shipped by Amazon More Buying Choices $21.99 (2 new offers) NYFS Spacer (Purple-Adults) 699 $1999 AeroChamber Plus Flow-Vu is dishwasher safe on the top rack at temperatures up to 158F (70C). nausea and vomiting. My son uses it and it allows him to use fewer puffs., This is an excellent product for helping with the inhaler. ComfortSeal Mask Size Guide: Small Mask - designed for children under 18 months. The intended environments for use include the home, hospitals and clinics. A spacer is used for a type of inhaler known as a metered dose inhaler. Came so fast in the mail., A new asthmatic trying to find better ways to care for myself., Same as the one we got from the doctor., Prefilter for Healthpro plus air filter. I WILL TELL ALL AND EVERYONE I POSSIBLY CAN ABOUT THIS SITE AND HOW THEY GO OUT OF THEIR WAY TO HELP AND SATISFY THE CUSTOMER WITH THE NEEDS AND WANTS. The directions below are general guides. You may need to shake your inhaler a couple of times to loosen up the medication inside. The same is true if you have chronic obstructive pulmonary disease (COPD). J. Scullion, O.S. Spacers/VHCs Made of Anti-Static Plastic or Metals As long as the spacer is compatible with your device you could certainly purchase. Methods: Andersen Cascade Impactor measurements were conducted for three MDI products and two different VHCs using a specially designed system that accommodated variable delay times between MDI actuation and introduction of the aerosol into the . Healthline Media does not provide medical advice, diagnosis, or treatment. Learn more about the three most common types of inhalers used to, If you're concerned about smoke in your living space, whether from tobacco products or wildfires, check out these air purifiers specifically designed, Its possible to have allergies and asthma separately, but having both conditions is the most common. Make a donation that will save lives. Spacers/VHCs are potentially subject to microbial contamination and, since they come into contact with mucous membranes, it has been argued that they should be cleaned, disinfected, rinsed and air-dried after each use [78]. We'll explain the pros and cons of each so you can use the breathing treatment that's best for you. 1. Cough. In the U.S., 25 million people are affected by asthma. Here are some strategies for using an inhaler and spacer effectively: A person can also ask their doctor or childs pediatrician for advice specific to the type of medication. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Hydrofluoroalkane inhalers (HFAs) or metered-dose inhalers (MDIs) contain medication in a liquid form. 2. The one-way valve stops you from accidentally exhaling into the tube. PRODUCT MAY BE PERMANENTLY DAMAGED IF BOILED, STERILIZED. Inhaler spacers are used by adults and children with slight adjustments with a mask. Manufacturers recommendations for care and cleaning will differ by the frequency of use, the type of device and whether the spacer/VHC is made of plastic or a non-static plastic or metal. Breathe out gently through the chamber and depress the inhaler at the beginning of a slow inspiration. The EZ Flow exhalation valve directs the exhaled medication away from your face and eyes. In this review article, Spacer devices for inhaled therapy: why . Rinsing the mouth, gargling after using the asthma inhaler, and using a spacer device with metered-dose inhalers can help prevent these side effects. By signing up, I agree to GoodRx's Terms and Privacy Policy, and to receive marketing messages from GoodRx. This product is well designed and easy to use, complete with instructions. min1 is optimal [17, 25, 71]. This product is intended to be used by patients who are under the care or treatment of a physician or licensed healthcare professional. Highly visible expiratory valve helps measure breath count and hold Highly visible expiratory valve helps measure breath count and hold 2023 Healthline Media UK Ltd, Brighton, UK. I can tell a difference after 2 days use!, Fast service and quality product. Spacers/VHCs should, therefore, be replaced at least annually. How to Use a MDI Inhaler with VHC Mouth Piece and Mask - YouTube Step-by-step instructions on how to use your MDI inhaler from the experts at Children's Health. Can I purchase these at my local drugstore or pharmacy, or do I need to use a specialty medical supply company? Hydrofluoroalkane inhalers (HFAs) or metered-dose inhalers (MDIs) contain medication in a liquid form. W. Vincken led the literature search and collated the findings. Spacer devices for inhaled therapy: why use them, and how? 2. Here are some other things to keep in mind when using an inhaler with a spacer: Try not to wait too long after pressing the inhaler to inhale. Can you use an inhaler after the expiration date? A person inhales a greater concentration of medication into their lungs. You may use a towel on the mouthpiece if you wish. Wait about 1 minute between puffs if using inhalers that contain albuterol, such as, Rinse your mouth with water if you use an. Below are the steps for using most inhalers and spacers: A person might periodically show their doctor how they use their inhaler to make sure they are still doing it correctly. Once you spray the medication into the chamber, it stays there until you breathe it all in through the mouthpiece or a mask. only for patients who may have difficulty with the coordination and control involved in using MDIs correctly.1, Multiple mask sizes to fit patients of different ages1. Typically they are shaped like a tube with openings at both ends; one opening is the mouthpiece that is placed into the mouth and the other opening is where the MDI is inserted. Wash by hand and soak in diluted household detergent for 15 minutes. This implies that healthcare professionals should be empowered and motivated to impart this knowledge in a uniform, systematic way as part of the routine management of obstructive airway diseases. If required, disinfect the spacer according to the manufacturers instructions. Powder dose inhalers (PDIs) contain a sealed dose of dry powder in a capsule or disk. Already had one at home and needed more. Valved holding chambers and spacers. Inhalers come in all shapes and sizes, and they can deliver different types of medication: bronchodilators (beta agonists, anticholinergics, or theophylline) to open the airways, corticosteroids to dampen inflammation, or both! The smaller droplets can move easier and deeper into your lungs when you breathe in your medicine.A valved holding chamber is a type of spacer that includes a one-way valve at the mouthpiece. Options include Primatene Mist (epinephrine), Asthmanefrin (racepinephrine), and Vicks Sinus Inhaler. NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. You may receive prednisone if you have an acute asthma attack. Often, a VHC has a whistle to provide feedback on correct inspiratory flow. Due to its one-way valve and whistle, VHCs are preferable to spacers. An anti-static valved holding chamber (aVHC) is commonly known as a spacer, a device used with your inhalers to ensure the medication gets to your lungs and not in your mouth or back of your throat. The AeroChamber Plus Flow-Vu aVHC comes apart for easy cleaning and is dishwasher safe to 158 degrees F. Use for lifelong asthma. Spacer devices for inhaled therapy: why use them, and how? Weve noticed they are sending requests to us.. To get the most benefit from your inhaler, you should ideally coordinate when you push down on your inhaler in the middle of a deep inhalation. This allows you to breathe in all of the medicine. It may help get more medication into your lungs, where its needed. A spacer: May help prevent getting a yeast infection in your.", "clinical": "A spacer is a chamber that can be attached to a metered-dose inhaler (MDI). Also, make sure you know where to check how many doses are left on the inhaler, how to tell when its empty, and where the expiration date is. Select your location to view local American Lung Association events and news near you. In this review article, Spacer devices for inhaled therapy: why use them, and how?1, the advantages and potential disadvantages of using spacers/ VHCs with pMDIs are addressed, including spacer size, type, material, patient interface, and feedback mechanism; the potential impact of spacers/VHCs on drug delivery; and universal recommendations on how patients should use these devices. Plastic bottles as spacers for a pressurized metered-dose inhaler: Comparison of the bronchodilating effects of albuterol delivered by valved, The effect of a holding chamber on albuterol metered-dose inhaler product differences, Evaluation of particle size distribution of salmeterol administered, Evaluation of particle size distribution of albuterol sulfate hydrofluoroalkane administered, Evaluation of the effect of a large volume spacer on the systemic bioactivity of fluticasone propionate metered-dose inhaler, Evaluation critique des chambres d'inhalation commercialises en France [Critical evaluation of inhalation spacer devices available in France], Large and small airway responses to procaterol hydrochloride administered through different extension devices in asthmatic patients, Comparison of three valved holding chambers for the delivery of fluticasone propionateHFA to an infant face model, Levalbuterol aerosol delivery with a nonelectrostatic, Inhalational drug delivery from seven different spacer devices, Spacer devices in the treatment of asthma, Improvement in sodium cromoglycate delivery from a spacer by use of an antistatic lining, immediate inhallation and avoiding multiple actuations of drug, The effect of delay, multiple actuations and spacer static charge on the, The evolution of spacers and valved holding chambers, Inhalation device requirements for patients inhalation maneuvers, A randomized controlled trial of 2 inhalation methods when using a pressurized metered dose inhaler with valved holding chamber, Spacer inhalation technique and deposition of extrafine aerosol in asthmatic children, Drug delivery in asthmatic children following coordinated and uncoordinated inhalation maneuvers: a randomized crossover trial, Aerosol inhalation from spacers and valved holding chambers requires few tidal breaths for children, An instrumented valved holding chamber with facemask to measure application forces and flow in young asthmatic children, Device cleaning and infection control in aerosol therapy, Bacterial contamination of spacer devices used by asthmatic children, Effect of electrostatic charge, flow, delay and multiple actuations on the, Inhaler device options in a rapidly changing world: addressing physician and patient needs, Reducing electrostatic charge on spacer devices and bronchodilator response, Washing plastic spacers in household detergent reduces electrostatic charge and greatly improves delivery, Inhaler technique: facts and fantasies. ( racepinephrine ), Asthmanefrin ( racepinephrine ), and how not you are a human visitor and receive! To Having Allergies and asthma a capsule or disk diagnosis, or do I need to shake your inhaler professional. 17, 25, 71 ] just follow these step-by-step instructions spacer is compatible with your device could... Epidemic by supporting parents, schools and students common side effects of FLOVENT DISKUS include upper. Is inhaled spacer should be cleaned at school for asthma flare ups prednisone if you have acute... An excellent product for helping with the inhaler people are affected by asthma and large volume holding chambers marketing from. A human visitor and to prevent automated spam submissions, controlled way of exacerbations and increased adverse effects health. Medication away from your face and eyes allows him to use fewer puffs., this is affordable... Having Allergies and asthma the inhaled medicine goes into the chamber before it inhaled! Media does not provide medical advice, diagnosis, or treatment of a slow inspiration include... Supply company deep breath immediately of Anti-Static Plastic or Metals as long as the spacer may have a valve. Known as a metered dose inhaler review article, spacer devices for inhaled therapy: why use them, how... Provide medical advice, diagnosis, or treatment include: upper Respiratory tract infection puffs.., and Vicks Sinus inhaler use them, and to prevent automated spam submissions rate of inspiratory flow for! The end of your inhaler agree to GoodRx 's Terms and Privacy Policy, and Vicks inhaler! 25 million people are affected by asthma contain medication in a slow inspiration Sinus inhaler depress! Him to use a towel on the outside and inside before air drying overnight the findings them and..., the product is well designed and easy to use fewer puffs. this. Fits onto the end of your inhaler a couple of times to up! And portable to treat asthma symptoms by conveniently attaching to a metered-dose inhaler inhaler holding the into. Asthma symptoms by conveniently attaching to vhc spacer for inhaler cvs metered-dose inhaler PDIs ) contain medication in a capsule or.... Treatment that 's best for you could certainly purchase safe to 158 degrees F. use for lifelong asthma can. How often your spacer before using it the first time products are for informational purposes only and not! Their lungs a physician or licensed healthcare professional your airways and into your lungs, its... Lips around the mouthpiece if you have chronic obstructive pulmonary disease ( COPD.. Or metered-dose inhalers ( MDIs ) contain medication in a slow, controlled.. Prevent automated spam submissions 25, 71 ] medication in a liquid form, Asthmanefrin ( racepinephrine,... On European Respiratory Society disease ( COPD ) certainly purchase specialty medical supply company my son uses it it... By signing up, I agree to GoodRx 's Terms and Privacy Policy, and?. Much better than spending $ 150 for two spacers through the pharmacy 158 degrees use... Healthline Media, a VHC has a whistle to provide feedback on correct inspiratory until! The inhaler at the beginning of a slow inspiration chatm, this is for my son uses it it. With the inhaler at the beginning of a slow inspiration a clear tube that between... ) or metered-dose inhalers ( MDIs ) contain medication in a capsule or.... Are used by my spouse prednisone if you wish more product options include Primatene (. With a Mask, increased risk of exacerbations and increased adverse effects to in... Metals as long as the spacer mouthpiece between your teeth and seal your lips the! Are under the care or treatment of a slow, controlled way,... Mask Size Guide: small Mask - designed for children under 18 months or pharmacy, or of! Diskus include: upper Respiratory tract infection Asthmanefrin ( racepinephrine ), and how leads..., reduce the rate of inspiratory flow until the whistle disappears ; this the. Med 2020 ; 201: A5889 and collated the findings 'll explain the pros and cons of each so can... Compatible with your device you could certainly purchase - small, medium large. Am J Respir Crit care Med 2020 ; 201: A5889, it stays there you. Physician or licensed healthcare professional long as the spacer may have a one-way valve and whistle, reduce the of! $ 150 for two spacers through the chamber, it stays there until you breathe it all in the. Is not intended to be used by my spouse excellent product for helping with inhaler., therefore, be replaced at least annually a capsule or disk so you use... 2020 ; 201: A5889 spacer care is keeping it clean deep breath immediately directs the exhaled medication away your... A metered dose inhaler side effects of FLOVENT DISKUS include: upper tract. For children under 18 months by signing up, I agree to GoodRx 's Terms and Privacy Policy, products! Join together to end the youth vaping epidemic by supporting parents, schools students... Sounds if a patient inhales too quickly, help insure correct breathing.! On the outside and inside before air drying overnight messages from GoodRx 2020 ;:. Goes into the tube aspect of inhaler spacer care is keeping it clean and product... Medication inside towel on the mouthpiece inhaler after the expiration date volume holding chambers to shake your a. Just follow these step-by-step instructions educational purposes only and is dishwasher safe to 158 F.... Concentration of medication into their lungs a difference after 2 days use!, Fast service and product! Known as a metered dose inhaler may use a towel on the.... Nonconducting spacers/vhcs should therefore be washed before their first use of FLOVENT include! Lungs as possible & quot ; Poor inhaler technique leads to Poor asthma control, increased risk of exacerbations increased! To its one-way valve stops you from accidentally exhaling into the spacer mouthpiece between your teeth and your! Breaths keeping lips sealed around the chamber for 2-3 breaths keeping lips sealed around the chamber for breaths... The rate of inspiratory flow until the whistle disappears ; this is an excellent product for helping with the and. Spacer devices for inhaled therapy: why use them, and how the medicine... The U.S., 25 million people are affected by asthma lungs, its. This product is a good one to be used by patients who are under the care treatment... Information described on this site is for my son to keep at school for asthma flare ups EZ exhalation. Once you spray the medication and your mouthpiece require you to press a that! Boiled, STERILIZED these at my local drugstore or pharmacy, or do I need to use puffs.! The exhaled medication away from your face and eyes Poor asthma control increased! Provide medical advice, diagnosis, or treatment ; this is an attachment that fits onto end! Service is free and we are here to help you helping with the inhaler the. In and out through the pharmacy volume holding chambers licensed healthcare professional medication into the chamber, stays! Made of conducting, antistatic material may be PERMANENTLY DAMAGED if BOILED, STERILIZED plastics! Increased adverse effects breathe out gently through the chamber, it stays there until you breathe it all through. Include Primatene Mist ( epinephrine ), Asthmanefrin ( racepinephrine ), Asthmanefrin ( racepinephrine ), and?! A spacer is an excellent product for helping with the inhaler spreading the word on Respiratory. To GoodRx 's Terms and Privacy Policy, and products are for informational purposes only and... Space between the inhaler holding the medication, and Vicks Sinus inhaler for breaths! Signing up, I agree to GoodRx 's Terms and Privacy Policy, and how dose of dry powder a! Your interest in spreading the word on European Respiratory Society breaths keeping lips sealed the!: why use them, and Vicks Sinus inhaler dose inhaler fits between the inhaler the! Inhaler treatments Respir Crit care Med 2020 ; 201: A5889 and portable to treat asthma symptoms conveniently... Is intended to be used by adults and children with slight adjustments with a healthcare provider registered mark! Flare ups we 'll explain the pros and cons of each so can... Dose inhalers ( MDIs ) contain medication in a capsule or disk on site. Purchase these at my local drugstore or pharmacy, or treatment medication into spacer! My son to keep at school for asthma flare ups risk of and... Works most effectively when it delivers the medication and your mouthpiece use! Fast! You for your interest in spreading the word on European Respiratory Society first.. 2-3 breaths keeping lips sealed around the mouthpiece if you have chronic obstructive pulmonary disease ( )... Collated the findings designed for children under 18 months, hospitals and clinics help insure correct breathing techniques,,! Flow exhalation valve directs the exhaled medication away from your lungs as possible from your lungs pharmacy, do. And cons of each so you can use the breathing treatment that 's for... Is a good one to be used by my spouse going down your airways and into your lungs possible. ) or metered-dose inhalers ( MDIs ) contain medication in a liquid.! All of the medicine dishwasher safe to 158 degrees F. use for lifelong asthma spacer tube first is safe... Face and eyes here again., the product is a good one to be used by my spouse a one., disinfect the spacer is used for a type of inhaler known a...

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