Comparison between traditional and nontraditional add-on devices used with pressurised metered-dose inhalers

Nicola, Mina; Soliman, Youssef; Hussein, Raghda R. S.; Saeed, Haitham; Abdelrahim, Mohamed

doi:10.1183/23120541.00073-2020

Cited by 12 publications

(18 citation statements)

References 27 publications

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“…Also, similar to the present in‐vivo study, the in‐vitro total emitted dose of salbutamol aerosol released through Spacers/VHCs with facemask has shown comparable total emitted dose values to mouthpiece 13 . The superiority in aerosol delivery from antistatic devices over non‐antistatic devices and the absence of a significant difference between facemasks and mouthpieces were found also in other in‐vitro studies 13‐16 …”

Section: Discussionsupporting

confidence: 88%

“…Therefore, placing accessory device (Spacers and valved holding chambers) between the pMDIs and the patient's mouth gives a chance for a better aerosol delivery as it provides more volume and space for the propellant to evaporate and provide smaller aerosol particles that could deposit deep into the lungs 13‐16 . Also, large particles, released by the pMDIs, mostly deposit within these accessory devices instead of being collected in the oral cavity and pharynx 14,17 …”

Section: Introductionmentioning

confidence: 99%

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Effect of different accessory devices on the dose delivered from pressurised metred‐dose inhalers

Nicola

Hussein

Soliman

et al. 2021

Int J Clinical Practice

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Introductions Improved aerosol delivery of bronchodilators to chronic obstructive pulmonary disease (COPD) subjects is a cornerstone in the treatment approach. Drug delivery and response are improved with the use of accessory devices [spacers and valved holding chambers (VHCs)] with metred‐dose inhalers (pMDIs). However, different accessory devices are available in the market with different properties that could affect aerosol delivery. Thus, this study aimed to assess the relative lung deposition and systemic bioavailability and compare bronchodilator response of salbutamol delivered using different accessory devices attached to pMDIs. Methods Twelve healthy subjects and twelve COPD subjects inhaled 300 μg salbutamol (3 pMDI puffs) using five different accessory devices with either masks or mouthpieces (Able, Aerochamber plus flow Vu, Dolphin chamber, Tipshaler spacer, and modified Drink bottle spacer). Urine samples were collected thirty minutes post‐dosing and cumulatively for the next twenty‐four hours, to determine and compare the relative lung deposition [0‐0.5 hour excretion of urinary salbutamol (USAL0.5)] and systemic bioavailability [0.5‐24 hours excretion of urinary salbutamol (USAL24)] of salbutamol from the selected accessory devices. Also, the difference between pre and post‐inhalation forced expiratory volume in one second (ΔFEV1%) of predicted was determined for each accessory device. Results Urinary excretion of salbutamol (both USAL0.5 and USAL24 samples) in COPD subjects was significantly (P < .05) lower than in healthy subjects for all accessory devices. USAL0.5 and USAL24 in non‐antistatic spacers (modified Drink bottle spacer and Dolphin chamber spacers) were significantly lower (P < .05) than that for antistatic spacers (Aerochamber plus flow Vu, Able and Tips‐haler). No significant difference in USAL0.5 and USAL24 was observed between facemasks and mouthpieces. There was a significant difference (P < .05) in ΔFEV1% of predicted values between COPD subjects and healthy subjects. However, within the COPD group and the healthy group there was no significant difference in ΔFEV1% of predicted values between all accessory devices or between with mouthpiece or with a mask. Conclusions COPD subjects had lower aerosol delivered compared with healthy subjects. Anti‐static accessory devices delivered a higher amount of aerosol compared with non‐antistatic accessory devices. Even though the presence of a significant difference in aerosol delivery between non‐antistatic and antistatic accessory devices no significant difference was found in the ΔFEV1% between all accessory devices.

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Effect of different accessory devices on the dose delivered from pressurised metred‐dose inhalers

Nicola

Hussein

Soliman

et al. 2021

Int J Clinical Practice

Self Cite

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“…18 Thus, they should use the MDI with a spacer, at least, at the early stage of disease control. 57 Our study supports the GINA update of 2020 insists on patient inhalation techniques for better asthma control. 6 Counselling enhanced the mean number of correct MDI steps accomplished by the subjects and lung function tests.…”

Section: Discussionsupporting

confidence: 80%

“…Also, most subjects of old age usually had osteoarthritis which might cause the inability to use their MDI easily 18 . Thus, they should use the MDI with a spacer, at least, at the early stage of disease control 57 . Our study supports the GINA update of 2020 insists on patient inhalation techniques for better asthma control 6 .…”

Section: Discussionsupporting

confidence: 75%

The potential benefit of continuous metered‐dose inhaler inhalation technique verbal counselling on asthmatic

et al. 2020

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Background Subjects’ improper usage of their metered‐dose inhalers (MDI) is considered a chief cause of poor asthma control. The work presented here aims to evaluate the effect of MDI verbal counselling on subjects’ lung function and inhalation technique. Method A total number of 900 asthmatic subjects (450 female) were gathered from University hospital outpatient clinics from January 2017 to May 2019 with a mean (SD) age 45.2 (17.1) years old. They were divided into two groups. The first was monthly asthma follow‐up, for three visits, (450 (266 females) subjects). The other group was monthly asthma follow‐up, for three visits plus MDI inhalation technique verbal counselling (450 (184 female) subjects). At the beginning of studying group 2 and at every monthly visit (three visits), each subject was asked to show the investigator his MDI inhalation technique and the number of mistakes was noticed and adjusted. Additionally, at each visit, their forced expiratory volume in one second (FEV1) as a percentage of the forced vital capacity (FVC) and peak expiratory flow (PEF) were measured. Results No subject dropped out from group 2; however, 95 subjects dropped out from group 1 with no improvement in the lung function tests. The mean number of accurate steps of the MDI inhalation technique observed in group 2 was improved significantly (P < .001) as the number of visits increased particularly in children. “Start to inhale slowly, through the mouth and at the same time press the canister to actuate a dose and maintain a slow and deep inhalation, through the mouth, until the lungs are full of air (This should take an adult 4‐5 seconds)” was the common repetitive mistake. There was a significant improvement (P < .05) in the lung function test scores after the counselling in group 2, especially in old subjects. Conclusions MDI’s counselling must be continually offered to the asthmatic subject at any possible chance to improve and sustain the optimal MDI inhalation technique and probably improve subjects’ lung function score.

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“…Although metered‐dose inhalers are the most popular and widely used devices in the therapy of asthma, 6,7 utilisation of metered‐dose inhaler (MDI) can lead to accumulation of the drug in the oropharynx region because of the dynamic steaming characters of aerosolised drug 6,8 . Also, there are some detectable drawbacks in the use of MDI devices that make them unfavourable for many patients, such as difficulties in synchronisation between MDI actuation and inhalation actions, unpleasant cold Freon chilling sensation in patients throat bases and the repeatable mistakes in inhalation approach 9‐11 . This increased the necessity for implementing assistant accessory devices such as spacers that can be positioned between the patient mouth and his MDI to introduce extra inhalation time and for enhancement of inhalation technique 1 .…”

Section: Introductionmentioning

confidence: 99%

Advanced counselling using training device and smartphone application on inhalation technique from metered‐dose inhaler with spacer equipped with different interfaces in asthmatic children

et al. 2021

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Background Spacers are equipped with either facemask or mouthpiece as an interface through which patient inhale their dose. The present study aimed to evaluate the effect of advanced counselling using training devices and smartphone applications on inhalation techniques from the metered‐dose inhaler (MDI) with a spacer equipped with different interfaces. Methods 100 paediatric asthmatic children (8‐18 years) were divided into two groups. Group one was a spacer with a mouthpiece (n = 50) and group two was a spacer with a facemask group (n = 50). Both groups had three visits one month apart. At each visit, patients were asked to show the investigator their inhalation technique using MDI with spacer, and mistakes were recorded and then patients were trained on the proper inhalation technique of using MDI with a spacer. In the spacer with mouthpiece group, Flo‐Tone was attached to the mouthpiece to allow the Trainhaler smartphone application to detect the duration of inhalation. In the spacer with facemask group, there was no need to use the Flo‐Tone training device since the facemask was equipped with a built‐in whistle detected by the Trainhaler smartphone application. Results The total number of mistakes in the inhalation technique decreased significantly (P < .05) in visits 2 and 3 for both groups. Duration of inhalation increased significantly (P < .05) in the mouthpiece group at visit 2 and in the facemask group at visit 3. Achieving 5 seconds of slow deep inhalation, breath‐holding for 5 seconds after inhalation and the tight fit of facemask represented the major obstacles in most children especially the youngest subjects. Breath out as far as comfortable had the highest number of mistakes in the first visit in both groups. Conclusion The Flo‐Tone with its positive reinforcement whistle and the Trainhaler smartphone application significantly improved the inhalation technique by decreasing the total number of mistakes especially in important steps eg, shaking MDI, maintaining slow inhalation rate, breath‐holding after inhalation and appropriate facemask fitting. Also, they increased the duration of inhalation of asthmatic children from MDI with a spacer. Both spacer interfaces are easy to handle once taught well.

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Comparison between traditional and nontraditional add-on devices used with pressurised metered-dose inhalers

Cited by 12 publications

References 27 publications

Effect of different accessory devices on the dose delivered from pressurised metred‐dose inhalers

Effect of different accessory devices on the dose delivered from pressurised metred‐dose inhalers

The potential benefit of continuous metered‐dose inhaler inhalation technique verbal counselling on asthmatic

Advanced counselling using training device and smartphone application on inhalation technique from metered‐dose inhaler with spacer equipped with different interfaces in asthmatic children

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