Lung Deposition of ^99mTc-Radiolabeled Albuterol Delivered through a Pressurized Metered Dose Inhaler and Spacer with Facemask or Mouthpiece in Children with Asthma

Abstract

Lung deposition achieved using the spacer with facemask was higher than previously reported, with a difference of only 4.4% of total dose measured compared to the deposition with mouthpiece. This may be due to a combination of factors including pMDI formulation, and use of an antistatic spacer with a flexible, well-fitting facemask.

In vitro drug delivery performance of five valved holding chambers with and without facemasks

“…On the other hand, the filter dose of salbutamol was much lower using Vortex with a facemask present than without it. Since the dead space of this mask is relatively low, leakage of air between the mask and the face model could explain the low amount of drug recovered from the filter …”

High-Flow Nasal Cannula and Aerosolized β Agonists for Rescue Therapy in Children With Bronchiolitis: A Case Series

“…The authors concluded that poor aerosol deposition was common when face mask techniques were used. Ditcham et al 13 administered radiolabeled salbutamol via a spacer or nebulizer and face mask to 8 infants and found that overall mask deposition was 0.8 -5.2% and fell to 0.6 -0.4% when children were agitated or screaming. Clay et al 14 found that changing drug concentration had little effect on aerosol size or drug mass median diameter during treatment, but that aerosol particle size remained at Ͻ 1.3 m when the optimal breathing dose range was Ͻ 5 m regardless of drug concentration.…”

“…This scoring system is a modified version of the Wood asthma scoring system, 6 is age-specific, and includes assessment of breathing frequency, S pO 2 , auscultation, retraction, and dyspnea. Scores range from mild (5-7) or moderate (8 -11) to severe (12)(13)(14)(15). In all patients, initial treatment consisted of 2 consecutive doses of 0.083% albuterol delivered by a jet nebulizer connected to a face mask using 100% oxygen.…”

Clinical Controversies in Aerosol Therapy for Infants and Children

“…26 This may have important clinical implications for patients who are receiving aerosolized artificial surfactant or who do not respond to bronchodilators using standard approaches (ie, bronchiolitis). Although these findings are interesting from a research standpoint, it is unreasonable from a cost standpoint to suggest vibrating mesh or ultrasonic nebulizers over jet nebulizers for routine delivery of drugs (ie, bronchodilators).…”

“…26 In fact, a mouthpiece may provide twice as much drug as a simple aerosol face mask. 25 A slow deep inhalation followed by an occasional breathhold may also help improve aerosol delivery to the lungs.…”