High-percentage lung delivery in children from detergent-treated spacers

Abstract

Pressurized metered‐dose inhalers attached to spacers are now the most common form of delivery of anti‐asthma medication in children. However, no reliable data are available of how much drug reaches the lungs in children of different ages. This information is crucial, as it determines the efficacy of therapy. In this study, we present information on the amount of drug reaching the lungs in children from a pressurized metered‐dose inhaler attached to a detergent‐coated spacer. We studied 18 asthmatic children inhaling radiolabeled salbutamol through detergent treated spacers to minimize electrostatic charge on the spacer wall. Lung deposition was much higher than expected when using detergent‐coated spacers. Mean (SD) lung deposition, expressed as a percentage of the total actuated dose (five actuations), was 16.4% (5.5) in younger children inhaling through a small volume spacer, and 28.2% (6.7) and 41.8% (3.8) in older children inhaling with different breathing patterns through a large volume spacer. These findings have major implications for dosage regimens for inhaled anti‐asthma medication in children. Lower doses may be sufficient for adequate drugs delivered through spacers treated for static to achieve a desired clinical response. Pediatr Pulmonol. 2000; 29:389–393. © 2000 Wiley‐Liss, Inc.

Distribution of technetium-99m-labelled QVARTMdelivered using an AutohalerTMdevice in children

“…Although younger children (5-7 yrs) received significantly less drug than older children using this device and formulation, the lung dose was still higher than that found with other devices and formulations in this age group [14][15][16][17]. However, the combined oropharyngeal and gastrointestinal dose was higher than that found in older children, and the use of a spacer may still be indicated in this age group.…”

The ADMIT series — Issues in Inhalation Therapy. 5) Inhaler selection in children with asthma

“…Typically lung deposition from the same pMDIspacer combination could be 1-2% in infants, 4-6% in children aged 2-6 years and 12% in a 10-year old child. [17][18][19][20][21] This is also one of the reasons why young children often need almost the same inhaled dose as older children to obtain the desired clinical effect.…”

Spacer inhalation technique and deposition of extrafine aerosol in asthmatic children

“…Drug swallowed into the gastrointestinal tract has little therapeutic value and may contribute to side-effects [11,18]. Spacer devices attached to pMDIs are recommended for children using inhaled corticosteroids, to reduce the impaction of the larger drug particles in the oropharynx and minimise drug reaching the gastrointestinal tract [19,20]. The aim of the present study was to use c-scintigraphy to assess the deposition of HFA-BDP delivered via a pMDI with an attached spacer (Aerochamber Plus TM ; Trudell Medical International, London, Canada) in children aged 5-17 yrs.…”