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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

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 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

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

J Med Assoc Thai 2016 Jul;99 Suppl 4:S265-74

Background: Inhaled bronchodilator treatment given via the pressurized metered-dose inhaler (pMDI) with spacer has been recommended for an acute asthma treatment. Unfortunately, most of commercially available spacers are at high cost while a do-it-yourself (DIY) spacer has lower cost as it is made from plastic bottle and siphon pump which are inexpensive and easilyfound materials.

Objective: This study aims to compare treatment response in nebulizer and DIY spacer used for asthmatic children. Read More

J Asthma 2017 03 15;54(2):173-185. Epub 2016 Jun 15.

e Division of Pediatric Pulmonary, Sleep Medicine and Integrative Systems Biology, Center for Genetic Research, Children's National Medical Center, George Washington University , Washington, DC , USA.

Objective: The objective of the present study was to perform a systematic review of instruments aimed at evaluating pressurized metered-dose inhaler (pMDI) administration technique in children and evaluating the measurement properties of these instruments.

Methods: A systematic search of the literature was performed in order to identify studies in which an instrument (scale, checklist, or questionnaire) for evaluating pMDI administration technique in children was described. Instruments were evaluated based on their reliability, validity, utility, endorsement frequency, restrictions in range, comprehension, lack of ambiguity, and lack of value-laden or offensive content. Read More

Eur J Pediatr 2016 Jul 1;175(7):1007-12. Epub 2016 Jun 1.

Clinical Sciences, Telethon Kids Institute, Subiaco, Western Australia, Australia, 6008.

Unlabelled: The importance of good device technique to maximise delivery of aerosolised medications is widely recognised. Pressurised metered dose inhaler (pMDI)-spacer technique was investigated in 122 children, aged 2-7 years, with asthma. Eight individual steps of device technique were evaluated before and after viewing an instructional video for correct device technique. Read More

J Aerosol Med Pulm Drug Deliv 2016 12 25;29(6):490-500. Epub 2016 May 25.

Department of Mechanical and Aerospace Engineering, Carleton University , Ottawa, Canada .

Background: Pressurized metered-dose inhalers (pMDIs) are commonly used to administer medication to patients suffering from chronic lower respiratory tract diseases such as asthma. Inhaling medication directly from a pMDI can prove difficult for some patients and, as a result, add-on devices (or spacers) have been designed to aid in the delivery of medication. Although spacers increase the percentage of medication that reaches the patient, medication will also nonsymmetrically deposit on the walls of the device and will be lost to the device itself. Read More

NASN Sch Nurse 2016 Jul 18;31(4):200-1. Epub 2016 May 18.

President and Chief Executive Officer, Allergy & Asthma Network, Vienna, VA.

Asthma is one of the most prevalent chronic diseases managed by school nurses, and its management often includes the administration of bronchodilators delivered via a metered dose inhaler (MDI). The use of an MDI requires coordination and mastery of steps that must be performed correctly and in the proper order. These steps are greatly enhanced, especially in the pediatric population, through the use of medical devices-spacers and valved holding chambers. Read More

J Asthma 2016 Dec 17;53(10):1059-62. Epub 2016 May 17.

c Department of Pediatrics , Karlstad Central Hospital , Karlstad , Sweden.

Objective: To compare administration of bronchodilators by nebulizers with delivery by metered dose inhalers (MDIs) with spacers and to evaluate the clinical effect of the treatment of acute asthma in preschool children.

Methods: A prospective randomized clinical trial in a pediatric emergency department (PED). Preschool children who were admitted for virus induced wheezing or acute asthma exacerbation were randomly allocated to receive bronchodilator treatment by nebulizer or by metered dose inhaler. Read More

Rev Mal Respir 2017 Jan 5;34(1):29-35. Epub 2016 May 5.

Unité de pneumopédiatrie, CHU Timone-Enfants, 13385 Marseille cedex 5, France.

Introduction: Use of a spacer device to optimize the delivery of fluticasone to infants with asthma is an important issue and clinicians require guidance around the choice of device. This in vitro study characterizes the particle size and the fluticasone delivery via 9 spacers.

Methods: We used an in vitro infant nasal cast with two different inspiratory flow rates (50 and 100mL/s). Read More

Acad Pediatr 2016 Sep-Oct;16(7):605-15. Epub 2016 Apr 26.

Marshall University Joan C. Edwards School of Medicine, Huntington, WVa.

Background: Pediatric asthma is an important public health problem worldwide. The primary methods of medication delivery are inhalation devices.

Objectives: This systematic review examined: 1) what is the prevalence of correct inhaler technique among children with asthma, 2) are educational interventions associated with improved rates of correct inhalation technique, and 3) is improved inhaler technique associated with improved asthma outcomes?

Data Sources: We included experimental and observational studies through searches of PubMed, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, CINAHL Complete, and clinicaltrials. Read More

Respir Care 2016 Jul 22;61(7):913-9. Epub 2016 Mar 22.

College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, Arkansas.

Background: Some pediatric tracheostomized patients who receive inhaled drugs undergo decannulation, and it is unknown whether the dose has to be adjusted. Pressurized metered-dose inhalers (pMDIs) and soft mist inhalers (SMIs) used with valved holding chambers (VHCs) made of non-electrostatic material are available. We hypothesized that using an SMI and changing the delivery route from tracheostomy to oronasal would increase lung dose. Read More

J Aerosol Med Pulm Drug Deliv 2016 08 29;29(4):386-92. Epub 2016 Jan 29.

2 GlaxoSmithKline , Stockley Park, Uxbridge, United Kingdom .

Background: The Mini Spacer has been developed for use with Ventolin(®) metered dose inhalers (MDIs) to improve accessibility to affordable spacers in developing countries. To ensure patient safety is not compromised if the Mini Spacer is used off-label with fluticasone propionate (FP) or salmeterol/FP combination (SFC) MDIs (currently not recommended), this study compared the systemic exposure of FP and salmeterol following delivery of FP and SFC MDIs with the Mini Spacer and the Aerochamber Plus(®) spacer (Aerochamber).

Methods: This was an open-label, randomized, single dose, crossover study in healthy subjects that evaluated four treatments: i) FP 250 μg MDI with Mini Spacer; ii) FP 250 μg MDI with Aerochamber; iii) SFC 25/250 μg with Mini Spacer; iv) SFC 25/250 μg with Aerochamber. Read More

Pharm Dev Technol 2017 Nov 25;22(7):871-880. Epub 2015 Nov 25.

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

Substituting spacer by another in noninvasive ventilation (NIV) involves many variables, e.g. total emitted dose (TED), mass median aerodynamic diameter (MMAD), type of spacer, total lung deposition and total systemic absorption, which must be adjusted to ensure patient optimum therapy. Read More

Pulm Med 2015 27;2015:176194. Epub 2015 Sep 27.

Clement Clarke International Limited, Edinburgh Way, Harlow, Essex CM20 2TT, UK.

The introduction of pressurised metered dose inhalers (MDIs) in the mid-1950s completely transformed respiratory treatment. Despite decades of availability and healthcare support and development of teaching aids and devices to promote better use, poor pMDI user technique remains a persistent issue. The main pMDI user aid is the spacer/valved holding chamber (VHC) device. Read More

Isr Med Assoc J 2015 Jul;17(7):421-4

Background: Treatment using inhaled bronchodilators for asthma with a metered dose inhaler attached to a spacer device (MDI+S) was shown to be as efficient as nebulizers. Nevertheless, nebulizers remain the treatment of choice in most hospitals.

Objectives: To implement a policy change to improve asthma treatment in pediatric wards and the pediatric emergency department. Read More

Int J Chron Obstruct Pulmon Dis 2015 8;10:1291-8. Epub 2015 Jul 8.

Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.

Background: Poor inhalation techniques are associated with decreased medication delivery and poor disease control in chronic obstructive pulmonary disease (COPD). The purpose of this study was to evaluate techniques for using inhaler devices in COPD patients.

Methods: A prospective cross-sectional study was conducted to assess patient compliance with correct techniques for using inhaler devices across four regimens, ie, the pressurized metered-dose inhaler (pMDI), the pMDI with a spacer, the Accuhaler, and the Handihaler. Read More

Rev Mal Respir 2015 Sep 8;32(7):672-81. Epub 2015 Jul 8.

Unité de pneumologie pédiatrique, CHU Timone-Enfants, AP-HM, 13000 Marseille, France. Electronic address:

Objective: To identify the spacer devices sold in France and to provide a critical evaluation in the light of the published data.

Materials And Methods: We contacted the pharmaceutical companies, manufacturers and distributors of each spacer in order to obtain their technical parameters and the results of any in vitro or in vivo studies. A review of the literature via PubMed completed the first set of data. Read More

Arch Pediatr 2015 May;22(5 Suppl 1):157-8

EA6305, CEPR, Faculté de médecine, Université François Rabelais, et DTF-Aerodrug, Faculté de Médecine, Tours, France.

Respir Care 2015 Dec 16;60(12):1743-8. Epub 2015 Jun 16.

Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.

Background: Information on the comparative efficacy of single deep breathing versus tidal breathing for inhaled asthma medications is limited, although such information can be of much use for the treatment of patients suffering from asthma. The objective of the present study was to compare the relative difference in improvement in peak expiratory flow (PEF) with single maximal inhalation with breath-holding versus 5 tidal breaths during inhalation of salbutamol from a pressurized metered dose inhaler (pMDI) with valved holding chamber (VHC) in children 5-15 y of age with asthma.

Methods: The randomized controlled trial was carried out on children with asthma between 5 and 15 y of age using a pMDI with a VHC either by a single deep breath with breath-hold or 5 tidal breaths. Read More

Respir Care 2015 Jun;60(6):858-74; discussion 874-9

Division of Respiratory Therapy, Georgia State University, Atlanta, Georgia.

Aerosolized medications are routinely used for the treatment of critically ill patients. This paper reviews aerosol delivery devices with a focus on issues related to their performance in pulmonary critical care. Factors affecting aerosol drug delivery to mechanically ventilated adults and spontaneously breathing patients with artificial airways are reviewed. Read More

Int J Pharm 2015 Aug 19;492(1-2):304-15. Epub 2015 May 19.

Boehringer Ingelheim Pharma GmbH & Co. KG, Analytical Development, Packaging Development Center, Binger Straße 173, 55216 Ingelheim am Rhein, Germany. Electronic address:

Medical devices are crucial for the proper administration of paediatric medicines to children, but handling and dosing errors commonly appear in daily practice. As both the understanding and the usage of medical devices for oral and respiratory drug administration are heterogeneous among patients and caregivers, the European Paediatric Formulation Initiative (EuPFI) consortium performed a European survey among healthcare professional stakeholders in France, Germany, Hungary, Italy, Spain and UK. The results show country- and age-dependent usage of devices for oral administration of liquid formulations, with a clear preference for oral droppers and syringes in the neonatal phase and in early infancy. Read More