Spacer inhalation technique and deposition of extrafine aerosol in asthmatic children

Abstract

The aim of the present study was to measure airway, oropharyngeal and gastrointestinal deposition of 99m Tc-labelled hydrofluoroalkane-beclomethasone dipropionate after inhalation via a pressurised metered-dose inhaler and spacer (Aerochamber Plus TM ) in asthmatic children.A group of 24 children (aged 5-17 yrs) with mild asthma inhaled the labelled drug. A total of 12 children took five tidal breaths after each actuation (tidal group). The other 12 children used a slow maximal inhalation followed by a 5-10-s breath-hold (breath-hold group). Simultaneous anterior and posterior planar c-scintigraphic scans (120-s acquisition) were recorded.For the tidal group, mean¡SD lung deposition (% ex-actuator, attenuation corrected) was 35.4¡18.3, 47.5¡13.0 and 54.9¡11.2 in patients aged 5-7 (n54), 8-10 (n54) and 11-17 yrs (n54), respectively. Oropharyngeal and gastrointestinal deposition was 24.0¡10.5, 10.3¡4.4 and 10.1¡6.2. With the breath-hold technique, lung deposition was 58.1¡6.7, 56.6¡5.2 and 58.4¡9.2. Oropharyngeal and gastrointestinal deposition was 12.9¡3.2, 20.1¡9.5 and 20.8¡8.8.Inhalation of the extrafine formulation with the breath-hold technique showed significantly improved lung deposition compared with tidal breathing across all ages. Oropharyngeal and gastrointestinal deposition was markedly decreased, regardless of which inhalation technique was applied, compared with a previous paediatric study using the same formulation delivered via a breath-actuated metered-dose inhaler.

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.…”

“…However, one study found that, when inhaling an extra fine particle formulation from a spacer, one deep inhalation followed by breath-holding resulted in significantly improved lung deposition compared with tidal breathing across all ages in children aged 4 -15 years. 18 In young children the parents should ensure that the valve is moving correctly. 32,36 Crying during the administration or air leakage between the face mask and the face due to a loosely fitting face mask markedly reduces the aerosol delivery to the intra-pulmonary airways (Table 1).…”

Evaluation of asthma control, parents’ quality of life and preference between AeroChamber Plus and AeroChamber Plus Flow-Vu spacers in young children with asthma

“…When compared to the improper use of a pMDI alone, inhalation of the dose through a pMDI connected to a spacer device significantly improved the aerosol lung deposition [1], [13], [14], and reduced both the oropharyngeal [15] and systemic [16] inhaled corticosteroid-related adverse effects.…”

Comparison of Pharmacokinetic and Pharmacodynamic Effects of Two Hydrofluoroalkane Formulations of Salmeterol

“…In the PK study with spacer, after an overnight fasting of at least 10 h, subjects self-administered a single dose of either test or reference product (salmeterol xinafoate HFA 25 μg/actuation × 4 puffs) with the help of a Volumatic spacer. Deep breathing technique was used for inhalation through the spacer device as it has a lesser variability as compared to tidal breathing method [27].…”