Search Our Scientific Publications & Authors

Dose Response 2020 Apr-Jun;18(2):1559325820917832. Epub 2020 Apr 7.

Department of Pharmaceutical Sciences, School of Pharmacy, Lebanese American University, Byblos, Lebanon.

Objectives: Asthma and chronic obstructive pulmonary disease (COPD) are chronic illnesses of the airways affecting a good number of people in Lebanon and the Middle East. Pressurized metered-dose inhalers (pMDIs) are important drug delivery systems used to treat such pulmonary diseases. Drugs proven to be valuable and effective may fail to act effectively if such inhalers are used incorrectly. Read More

Eur J Intern Med 2020 May 26;75:15-18. Epub 2020 Feb 26.

Division of Respiratory Medicine, Department PROMISE, "Giaccone" University Hospital, University of Palermo, Italy.

Inhalation therapy allows conveying drugs directly into the airways. The devices used to administer inhaled drugs play a crucial role in the management of obstructive lung diseases such as asthma and chronic obstructive pulmonary disease (COPD). To ensure high bronchial deposition of the drug, a device should deliver a high proportion of fine particles, be easy to use, and provide constant and accurate doses of the active substance. Read More

J Allergy Clin Immunol Pract 2020 May 9;8(5):1569-1573. Epub 2020 Jan 9.

Imperial College London & Royal Brompton Hospital, London, United Kingdom.

Spacers are pressurized metered-dose inhaler (pMDI) accessory devices developed to reduce problems of poor inhaler technique with pMDIs. Spacers that feature a 1-way inspiratory valve are termed valved holding chambers (VHCs); they act as aerosol reservoirs, allowing the user to actuate the pMDI device and then inhale the medication in a 2-step process that helps users overcome challenges in coordinating pMDI actuation with inhalation. Both spacers and VHCs have been shown to increase fine particle delivery to the lungs, decrease oropharyngeal deposition, and reduce corticosteroid-related side effects such as throat irritation, dysphonia, and oral candidiasis commonly seen with the use of pMDIs alone. Read More

Laryngorhinootologie 2019 Dec 6;98(12):845-860. Epub 2019 Dec 6.

Mundipharma GmbH.

Aim Of The Literature Review: Within this review, results of a literature analysis on the application of spacers with pressurized metered dose inhalers (pMDI) are described and evaluated.

Methods: Next to an extensive revision on effects of spacers, the impacts of current guidelines and the conditions for product authorisations on the use of spacers are described which result from the interplay of characteristics from dose inhalers with a spacer.

Results: Spacers are generally useful to avoid coordination problems concerning the actuation of a pMDI at the beginning of an inhalation. Read More

Ther Adv Respir Dis 2019 Jan-Dec;13:1753466619884532

Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus C, Denmark.

Inhaled therapies are the cornerstone of treatment in asthma and chronic obstructive pulmonary disease, and there are a multitude of devices available. There is, however, a distinct lack of evidence-based guidance for healthcare providers on how to choose an appropriate inhaler. This review aims to summarise recent updates on topics related to inhaler choice, and to offer practical considerations for healthcare providers regarding currently marketed devices. Read More

Int Forum Allergy Rhinol 2020 01 1;10(1):69-74. Epub 2019 Oct 1.

Pediatric Allergy and Immunology Department, GOP Taksim Education and Research Hospital, İstanbul, Turkey.

Background: Pressurized metered-dose inhalers (pMDIs) used with spacers are considered the method of choice for delivery of inhaled drugs in preschool-age children. The aim of this study was to determine the effects of modifying the visual inhaler spacer usage guidelines on the correct usage rate.

Methods: The parents and caregivers of patients <6 years old who were prescribed inhalers with spacers for the first time were included in our study. Read More

Respir Care 2020 Mar 27;65(3):320-325. Epub 2019 Aug 27.

Pharmaceutics and Industrial Pharmacy Department, Beni-suef University, Beni-suef, Egypt.

Background: The use of accessory devices with pressurized metered-dose inhalers (pMDIs) enhances aerosol delivery and helps overcome any lack of patient coordination when using the pMDI. The use of accessory devices could be influenced by the efficacy, availability, and cost of these devices. The aim of this study was to compare drug delivery with the pMDI alone and with non-antistatic and antistatic accessory devices. Read More

Can Respir J 2019;2019:6475651. Epub 2019 Jul 25.

Pediatric Department, University of Alberta, Edmonton, AB T6G2C6, Canada.

Pediatr Pulmonol 2019 09 8;54(9):1417-1421. Epub 2019 Jul 8.

Department of Pediatrics, UFCSPA, Porto Alegre, RS, Brazil.

Introduction: Aerosol therapy using a metered-dose inhaler (MDI) coupled to a spacer chamber is the most widely used long-term treatment modality for chronic lung disease of prematurity. However, its use in neonates is based on data obtained from other age groups. Proper use of maintenance treatment is essential for the long-term stability of these patients. Read More

Pediatr Pulmonol 2019 09 29;54(9):1457-1465. Epub 2019 Jun 29.

Allergy Centre, Tampere University Hospital, Tampere, Finland.

Background: Valved holding chambers (VHCs) are essential for efficient pulmonary delivery of inhaled medication in preschool children. The numerous devices in the market vary in material, aerodynamic characteristics, volume, valve properties, and mask design. Drug delivery is affected by the VHC characteristics as well as by the age and breathing pattern of the child. Read More

Respir Care 2019 Oct 28;64(10):1222-1230. Epub 2019 May 28.

Inhalation Consultancy Limited, Leeds, United Kingdom.

Background: The drug delivery characteristics of each inhaler/spacer combination are unique. The spacer size as well as the presence of electrostatic charge greatly influence the inhaler dose emission and in vivo delivery. Using a previously developed urinary pharmacokinetic method, we have measured the relative lung and systemic bioavailability of beclometasone dipropionate (BDP) after inhalation from 2 hydrofluroalkane-beclometasone dipropionate (HFA-BDP) formulations when used with a spacer. Read More

Perspect Clin Res 2019 Apr-Jun;10(2):67-72

Global Medical Affairs, Cipla Limited, India.

Aim: This study aimed to evaluate the doctors' perspectives in using tools for diagnosis, prescribing medications, and devices for the treatment of asthma in Algeria.

Methods: Data were collected from randomly selected physicians, pediatricians, allergists, and pulmonologists through a questionnaire-based survey in 12 cities and 60 rural locations across Algeria.

Results: Of the 213 doctors who responded to the survey, >90% doctors attended an average of 20 asthma patients daily. Read More

Pediatr Pulmonol 2019 04 22;54(4):372-377. Epub 2019 Jan 22.

Division of Pediatrics, Emergency Department, Clinical Hospital, National University of Asunción, Asunción, Paraguay.

Introduction: In moderate-severe asthma exacerbation, salbutamol by inhaler (MDI) is superior to salbutamol delivered by nebulizer (NEB); however, to our knowledge, no studies in children with exclusively severe exacerbations were performed.

Objective: To compare the efficacy of salbutamol and ipratropium bromide by MDI versus by NEB in severe asthma exacerbations.

Methods: We performed a clinical trial enrolling 103 children (2-14 years of age) with severe asthma exacerbations (defined by the Pulmonary Score ≥ 7) seen at the emergency room in Asuncion, Paraguay. Read More

Can Respir J 2018 3;2018:3095647. Epub 2018 Sep 3.

Respiratory Center, Hospital de Niños Dr. Ricardo Gutiérrez, Buenos Aires, Argentina.

Background: In vitro and scintigraphic studies have suggested that effectiveness of metered-dose inhalers (MDI) with nonvalved spacers (NVS) is similar to that of MDI with valved holding chambers (VHC). Nevertheless, there are no clinical studies that compare these techniques in long-term treatment with inhaled steroids in young children with recurrent wheezing and risk factors for asthma.

Objective: To compare the efficacy of a long-term treatment with Fluticasone Propionate administered by an MDI through both type of spacers, with and without valves, in young children with recurrent wheezing and risk factors for asthma. Read More

Pharm Res 2018 Aug 21;35(10):194. Epub 2018 Aug 21.

Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University, 401 West Main Street, P.O. Box 843015 Richmond, Virginia, 23284-3015, USA.

Purpose: To demonstrate efficient aerosol delivery through an in vitro nasal model using a dry powder inhaler (DPI) requiring low actuation air volumes (LV) applied during low-flow nasal cannula (LFNC) therapy.

Methods: A previously developed LV-DPI was connected to a LFNC system with 4 mm diameter tubing. System connections and the nasal cannula interface were replaced with streamlined components. Read More

Respir Care 2018 Nov 7;63(11):1360-1369. Epub 2018 Aug 7.

Clinical Pharmacy Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt.

Background: Predosing patients with COPD with salbutamol by using a pressurized metered-dose-inhaler (pMDI) as a bronchodilator was hypothesized to improve the distribution of the subsequent nebulized dose. This study determined the effect of a pMDI preliminary bronchodilator dose on the aerosol delivered by a mesh nebulizer during single-limb noninvasive ventilation.

Methods: Twelve subjects with COPD who received noninvasive ventilation were enrolled in a randomized, open-label, urinary pharmacokinetic study. Read More

Pulm Pharmacol Ther 2018 10 2;52:7-17. Epub 2018 Aug 2.

AstraZeneca, Pepparedsleden 1, 431 50, Mölndal, Gothenburg, Sweden. Electronic address:

Introduction: Many patients with chronic obstructive pulmonary disease or asthma experience difficulties in coordinating inhalation with pressurized metered-dose inhaler (pMDI) actuation. The use of a spacer device can improve drug delivery in these patients. The aim of this study was to establish the relative bioavailability of single doses of Symbicort (budesonide/formoterol) pMDI 160/4. Read More

Can Respir J 2018 4;2018:5076259. Epub 2018 Apr 4.

Family Physician Airways Group of Canada, Richmond Hill, ON, Canada.

Valved holding chambers (VHCs) have been used with pressurized metered-dose inhalers since the early 1980s. They have been shown to increase fine particle delivery to the lungs, decrease oropharyngeal deposition, and reduce side effects such as throat irritation, dysphonia, and oral candidiasis that are common with use of pressurized metered-dose inhalers (pMDIs) alone. VHCs act as aerosol reservoirs, allowing the user to actuate the pMDI device and then inhale the medication in a two-step process that helps users overcome challenges in coordinating pMDI actuation with inhalation. Read More

Respir Care 2018 Sep 22;63(9):1125-1131. Epub 2018 May 22.

Clinical Pharmacy Department, Faculty of Pharmacy, Beni-suef University, Beni-suef, Egypt.

Background: A new holding chamber was designed to be used with the Aerogen Solo nebulizer to increase the aerosol emitted that reach the patient. The aim of this study was to evaluate the efficacy of this holding chamber with the nebulizer and determine its usability with other nebulizers.

Methods: The study was divided into 2 parts. Read More

Int J Pharm 2018 Jul 5;546(1-2):1-9. Epub 2018 May 5.

Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University, Richmond, VA, United States; Department of Pharmaceutics, Virginia Commonwealth University, Richmond, VA, United States. Electronic address:

Inline dry powder inhalers (DPIs) offer a potentially effective option to deliver high dose inhaled medications simultaneously with mechanical ventilation. The objective of this study was to develop an inline DPI that is actuated using a low volume of air (LV-DPI) to efficiently deliver pharmaceutical aerosols during low flow nasal cannula (LFNC) therapy. A characteristic feature of the new inline LV-DPIs was the use of hollow capillary tubes that both pierced the capsule and provided a pathway for inlet air and exiting aerosol. Read More

Respir Med 2018 05 30;138:74-80. Epub 2018 Mar 30.

AstraZeneca, Gaithersburg, MD, USA.

Objectives: This study compared the efficacy, pharmacokinetics (PK), and safety of GFF MDI (Bevespi Aerosphere), a fixed-dose combination of glycopyrronium and formoterol fumarate dihydrate (14.4/10 μg) delivered by a metered dose inhaler (MDI) formulated using innovative co-suspension delivery technology, in patients with moderate-to-very severe chronic obstructive pulmonary disease (COPD) with and without the Aerochamber Plus Flow-Vu valved holding chamber (VHC).

Methods: In this multicenter, open-label, crossover, Phase III study (NCT02454959), patients were randomized to receive GFF MDI 14. Read More

Int J Chron Obstruct Pulmon Dis 2018;13:1309-1316. Epub 2018 Apr 23.

Division of Pulmonary and Critical Care Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi City, Taiwan.

Purpose: Respiratory inhalers, which directly deliver medication to the airway, are important for controlling symptoms and preventing exacerbations of chronic obstructive pulmonary disease (COPD). The inhaler misuse rate of patients with COPD in Taiwan is unclear. In this study, the inhaler techniques and patient characteristics associated with incorrect inhaler techniques among patients with COPD were evaluated. Read More

Respir Med 2018 04 7;137:181-190. Epub 2018 Mar 7.

Trudell Medical International, London, Ontario, Canada. Electronic address:

Background: When characterizing inhalation products, a comprehensive assessment including in vitro, pharmacokinetic (PK), and clinical data is required. We conducted a characterization of tiotropium Respimat when administered with AeroChamber Plus Flow-Vu anti-static valved holding chamber (test VHC) with face mask in 1-5-year-olds with persistent asthmatic symptoms.

Methods: In vitro tiotropium dose and particle size distribution delivered into a cascade impactor were evaluated under fixed paediatric and adult flow rates between actuation and samplings. Read More

Expert Opin Drug Deliv 2018 04 12;15(4):419-430. Epub 2018 Feb 12.

c GSK , Respiratory, Global Classic & Established Products , Singapore.

Introduction: Spacers offer a multitude of benefits by reducing the requirement to coordinate inhalation with actuation and improving inhaler technique in patients using a pressurized metered dose inhaler (pMDI). Spacers improve drug targeting by retaining within the spacer large particles normally deposited in the oropharynx, and by creating a prolonged aerosol cloud of fine particles to give the user increased time to inhale after actuation. This is particularly important in young children and the elderly to effectively deliver medication to the airways. Read More

J Am Pharm Assoc (2003) 2018 May - Jun;58(3):296-302. Epub 2018 Feb 3.

Objectives: To use a pharmacist-managed short-acting beta agonist (SABA) service (1) to determine the patient's rationale for SABA refill requests, (2) to assess adherence to current controller therapy and current level of disease control, and (3) to characterize the pharmacist's recommendations made in response to a patient's SABA refill request.

Setting: An academic-based general pediatric clinic.

Practice Description: SABA overuse is a marker of increased morbidity and mortality in children with asthma. Read More

Ther Adv Respir Dis 2018 Jan-Dec;12:1753465817751346

Trudell Medical International, London, Ontario, Canada.

Valved holding chambers (VHCs) reduce the need for inhalation-actuation coordination with pressurized metered dose inhalers (pMDIs), reduce oropharyngeal drug deposition and may improve lung deposition and clinical outcomes compared to pMDIs used alone. While VHCs are thus widely advocated for use in vulnerable patient groups within clinical and regulatory guidelines, there is less consensus as to whether the performance differences between different VHCs have clinical implications. This review evaluates the VHC literature, in particular the data pertaining to large- versus small-volume chambers, aerosol performance with a VHC adjunct versus a pMDI alone, charge dissipative/conducting versus non-conducting VHCs, and facemasks, to ascertain whether potentially meaningful differences between VHCs exist. Read More

BMJ 2017 12 29;359:j5763. Epub 2017 Dec 29.

Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, London, UK.

Pulm Pharmacol Ther 2018 02 10;48:179-184. Epub 2017 Oct 10.

Trudell Medical International, 725 Third Street, London, Ontario N5V 5G4, Canada. Electronic address:

Introduction: The European Medicines Agency (EMA) requires that a specific valved holding chamber (VHC) is designated for use with a given pressurised metered dose inhaler (pMDI). No other regulatory authorities impose similar requirements, implying that VHCs are interchangeable. This in vitro study, employing EMA assessment criteria, assessed the equivalence of four anti-static VHCs (aVHCs) versus the non-conducting VHC most widely referenced in pMDI monographs, the AeroChamber Plus™ (AC+) VHC. Read More

J Allergy Clin Immunol Pract 2018 Jan - Feb;6(1):307-309. Epub 2017 Sep 29.

Asthma and Airways Disease Research Center, University of Arizona, Tucson, Ariz; Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Ariz.

J Aerosol Med Pulm Drug Deliv 2017 Dec 28;30(6):444-450. Epub 2017 Aug 28.

2 PS5 Consultants Ltd , Portsmouth, United Kingdom .

Background: Although delivery of drugs from pressurized metered dose inhalers (pMDIs) via spacer devices is widespread it cannot be assumed that patients take their medication as prescribed or use their spacer appropriately. We developed a Spacer Data Logger device to record patient adherence and whether patients had shaken the pMDI, actuated it soon after shaking, and inhaled a sufficient volume from it.

Methods: We report an assessment of the Spacer Data Logger to measure and record that the pMDI was adequately shaken, the time to actuation, and the volume "inhaled" from the spacer up to 26 seconds after actuation. Read More

J Aerosol Med Pulm Drug Deliv 2017 Dec 28;30(6):399-410. Epub 2017 Aug 28.

6 Division of Pharmaceutical Analysis, Center for Drug Evaluation and Research , U.S. Food and Drug Administration, St. Louis, Missouri (Retired).

Background: Multiple factors may influence the performance of a metered dose inhaler (MDI) when used with a valved holding chamber (VHC or "spacer").

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 impactor, and allowed reduced flow through the VHC while the impactor was operated at 28.3 L/min. Read More

Pneumologie 2017 Jul 12;71(7):437-453. Epub 2017 Jul 12.

Mundipharma GmbH, Limburg.

 Within this review, results of a literature analysis on the application of spacers with pressurized metered dose inhalers (pMDI) are described and evaluated.  Next to an extensive revision on effects of spacers, the impacts of current guidelines and the conditions for product authorisations on the use of spacers are described which result from the interplay of characteristics from dose inhalers with a spacer.  Spacers are generally useful to avoid coordination problems concerning the actuation of a pMDI at the beginning of an inhalation. Read More

Int J Pharm 2017 Aug 4;529(1-2):264-274. Epub 2017 Jul 4.

Dept. of Pharmaceutical Sciences, University of Connecticut, CT 06269, USA; Institute of Materials Science, University of Connecticut, Storrs, CT 06269, USA. Electronic address:

The use of Pressurized metered dose inhalers (pMDIs) for the treatment of asthma and other chronic obstructive pulmonary diseases is frequently associated with breath-actuation synchronization problems and poor pulmonary delivery, particularly amongst the pediatric and geriatric population groups. Spacers, or Valved Holding Chambers (VHCs), are frequently used to address these problems. However, the performance of spacers with different pMDIs is also highly variable and needs to be investigated. Read More

Allergy Asthma Clin Immunol 2017 29;13:30. Epub 2017 Jun 29.

Broadgate House, 22 Broadgate, Great Easton, Leicestershire, LE16 8SH UK.

Background: Current pressurised metered dose asthma inhaler (pMDI) propellants are not inert pharmacologically as were previous chlorofluorocarbons, have smooth muscle relaxant' partial pressure effects in the lungs and inhaled hydrofluoroalkane 134a (norflurane) has anaesthetic effects. Volumes of propellant gas per actuation have never been measured.

Methods: In-vitro studies measured gas volumes produced by pMDIs on air oxygen (O) levels in valved holding chambers (VHC) and the falls in O% following actuation into lung ventilator delivery devices. Read More

Pulm Pharmacol Ther 2017 08 13;45:159-163. Epub 2017 Jun 13.

Clinical Pharmacy Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt; Clinical Pharmacy Department, Faculty of Pharmacy, Ahram Canadian University, Giza, Egypt. Electronic address:

Background: Patient receiving invasive mechanical ventilation (IMV) may benefit from medical aerosol, but guidance on dosing with different aerosol devices is limited to in-vitro studies. The study was designed to compare aerosol delivery with five different types of aerosol generators during IMV.

Method: In randomized design, 60 (30 female) mechanically ventilated chronic obstructive pulmonary disease (COPD) patients were assigned to one of 5 groups. Read More

J Allergy Clin Immunol Pract 2017 Nov - Dec;5(6):1787-1788. Epub 2017 May 19.

Division of Allergy, Pulmonary, and Critical Care, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn; Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tenn; Center for Biomedical Ethics and Society, Vanderbilt University, Nashville, Tenn. Electronic address:

Respir Med 2017 05 22;126:52-58. Epub 2017 Mar 22.

Center for Research in Allergy and Clinical Immunology, Health Sciences Post-Graduation Program, Clinical Hospital, Federal University of Pernambuco, Recife, Brazil. Electronic address:

Background: Holding chambers or spacers can enhance the efficacy of pressurized metered dose inhalers (pMDI) in delivering inhaled medications, as they reduce the need for hand-breath coordination and improve lower airways deposition. Nevertheless, their cost can be high for patients in low-income countries.

Objective: To compare asthma control achieved with beclomethasone-dipropionate administered through a hydrofluoroalkane-driven pMDI (BDp-pMDI) coupled to a home-made spacer (HmS) or to a valved commercial spacer (VCS) as auxiliary devices. Read More

J Pharm Sci 2017 06 24;106(6):1553-1559. Epub 2017 Feb 24.

Faculty of Pharmacy, The University of Sydney, Sydney, New South Wales 2006, Australia. Electronic address:

Aerosols emitted from metered dose inhalers (MDIs) are generally electrically charged and bipolar in nature. Although a spacer can effectively dampen the charge magnitude of aerosols, the electrostatic interactions between the positively and negatively charged particles and the spacer have not yet been characterized separately. The Bipolar Charge Analyzer (BOLAR) was employed to investigate interactions between the spacer and the charged aerosols. Read More

J Allergy Clin Immunol Pract 2017 Jul - Aug;5(4):1040-1049.e4. Epub 2017 Jan 18.

Observational and Pragmatic Research Institute Pte Ltd, Singapore; Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom. Electronic address:

Background: Spacers are often used with pressurized metered-dose inhalers (pMDIs) to eliminate the need for coordinating inhalation with actuation.

Objective: To investigate the real-life effectiveness of spacers prescribed for use with either extrafine- or fine-particle inhaled corticosteroids (ICSs).

Methods: This historical matched cohort study examined anonymous medical record data over 2 years (1-year baseline, 1-year outcome) for patients with asthma aged 12 to 80 years initiating ICSs by pMDI with or without prescribed spacer. Read More

J Aerosol Med Pulm Drug Deliv 2017 Jun 15;30(3):182-189. Epub 2016 Dec 15.

4 InDevCo AB , Nyköping, Sweden .

Background: Valved holding chambers (VHCs) are used in children to deliver pressurized metered dose inhalers (pMDI). In vitro data suggest that uncoordinated use decreases the amount of drug available for inhalation. We hypothesize that in an ex vivo study, the coordinated maneuver will deliver more drug than the uncoordinated one. Read More

Rev Mal Respir 2017 May 15;34(5):561-570. Epub 2016 Nov 15.

Unité de pneumologie pédiatrique, CHU Timone Enfants, Assistance publique-Hôpitaux de Marseille, 13000 Marseille, France.

Introduction: Inhaled therapy is the mainstay of asthma treatment due to its local and rapid action. However, its efficiency relies on the teaching of a good inhalation technique by health care providers. We assessed health care providers' knowledge and practical skills in the use of inhalation devices. Read More

Pharm Res 2017 02 7;34(2):290-300. Epub 2016 Nov 7.

Institut de Recherche Expérimentale et Clinique (IREC), Pneumologie, ORL & Dermatologie, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium.

Purpose: To compare in vivo the total and regional pulmonary deposition of aerosol particles generated by a new system combining a vibrating-mesh nebulizer with a specific valved holding chamber and constant-output jet nebulizer connected to a corrugated tube.

Methods: Cross-over study comparing aerosol delivery to the lungs using two nebulizers in 6 healthy male subjects: a vibrating-mesh nebulizer combined with a valved holding chamber (Aerogen Ultra®, Aerogen Ltd., Galway, Ireland) and a jet nebulizer connected to a corrugated tube (Opti-Mist Plus Nebulizer®, ConvaTec, Bridgewater, NJ). Read More

Clin Pediatr (Phila) 2016 Oct;55(11):1050-3

Joan C. Edwards Marshall University School of Medicine, Huntington, WV, USA

Studies show the delivery of inhaled medications is maximized when a metered-dose inhaler (MDI) with a spacer is utilized. Our residents expressed concern with their knowledge of MDIs and spacers. This study was designed to address those concerns. Read More

Ann Allergy Asthma Immunol 2016 09;117(3):246-50

Department of Pharmaceutical Sciences, The University of Arizona College of Pharmacy, Tucson, Arizona.

Background: Three albuterol sulfate metered-dose inhaled (MDI) products (Ventolin HFA, Proventil HFA, and ProAir HFA) are marketed in the United States to provide the same total dose of albuterol sulfate. However, it is widely known that the fine particle dose (<5 μm) is the portion of the particle distribution that actually reaches the lungs and provides therapeutic benefit.

Objective: To examine the differences in particle size between products and how a valved holding chamber (VHC) can mitigate possible adverse effects. Read More

J Vet Pharmacol Ther 2017 Jun 4;40(3):231-238. Epub 2016 Sep 4.

Royal (Dick) School of Veterinary Studies and Roslin Institute, Easter Bush Veterinary Centre, Midlothian, UK.

Despite frequent use of metered dose inhalers (MDIs) and spacers in equine practice, limited information exists on the efficiency of aerosol delivery using such devices. We determined the particle size distribution within an MDI-generated salbutamol aerosol delivered via an equine spacer using 'best practice' delivery technique and assessed the effect of variations in MDI use technique (shaking prior to each actuation, rapid repetitive actuations, and MDI angulation) on aerosol delivery efficiency. Under optimal conditions, only 53(±18) μg salbutamol per 100 μg actuation was delivered beyond the spacer. Read More

Cochrane Database Syst Rev 2016 Aug 29(8):CD011826. Epub 2016 Aug 29.

Department of Pulmonary Diseases and Tuberculosis, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, Netherlands, 9713 GZ.

Background: Bronchodilators are a central component for treating exacerbations of chronic obstructive pulmonary disease (COPD) all over the world. Clinicians often use nebulisers as a mode of delivery, especially in the acute setting, and many patients seem to benefit from them. However, evidence supporting this choice from systematic analysis is sparse, and available data are frequently biased by the inclusion of asthma patients. Read More

Chest 2017 06 11;151(6):1345-1355. Epub 2016 Aug 11.

Airways Disease Section, National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital, London, England.

During the past decade, there has been increasing evidence that the small airways (ie, airways < 2 mm in internal diameter) contribute substantially to the pathophysiologic and clinical expression of asthma and COPD. The increased interest in small airways is, at least in part, a result of innovation in small-particle aerosol formulations that better target the distal lung and also advanced physiologic methods of assessing small airway responses. Increasing the precision of drug deposition may improve targeting of specific diseases or receptor locations, decrease airway drug exposure and adverse effects, and thereby increase the efficiency and effectiveness of inhaled drug delivery. Read More

CJEM 2017 Jan 10;19(1):1-8. Epub 2016 Aug 10.

‡Department of Emergency Medicine,Dalhousie University,Halifax,NS.

Background: Despite evidence demonstrating the advantages of metered-dose inhalers with spacers (MDI-s), nebulization (NEB) remains the primary method of asthma treatment in some pediatric emergency departments (PEDs). There is a perception that delivering salbutamol by MDI-s is more costly than by NEB. This research evaluates the relative costs of MDI-s and NEB using local, hospital-specific, patient-level data. Read More

Tuberk Toraks 2016 Jun;64(2):105-11

Department of Pediatric Allergy and Pulmonology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey.

Introduction: Improper Metered Dose Inhaler (MDI)-spacer use technique can result in less than optimal delivery of medicine to the lungs and poor asthma outcomes. The aim of this study was to evaluate the influence of standardized education on proper MDI- spacer use and asthma control in children with asthma and to identify the factors associated with these results.

Materials And Methods: This is a cohort study that evaluated the influence of standardized education about MDI-Spacer device use on asthma control in children. Read More

Adv Pharm Bull 2016 Jun 30;6(2):257-60. Epub 2016 Jun 30.

Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.

Purpose: Respiratory drug delivery has been attracted great interest for the past decades, because of the high incidence of pulmonary diseases. However, despite its invaluable benefits, there are some major drawbacks in respiratory drug delivery, mainly due to the relatively high drug deposition in undesirable regions. One way to improve the efficiency of respiratory drug delivery through metered-dose inhalers (MDI) is placing a respiratory spacer between the inhaler exit and the mouth. Read More