292 results match your criteria Use of Metered Dose Inhalers Spacers and Nebulizers


Inhalation therapy devices for the treatment of obstructive lung diseases: the history of inhalers towards the ideal inhaler.

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

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http://dx.doi.org/10.1016/j.ejim.2020.02.023DOI Listing
May 2020
2.300 Impact Factor

[Spacer, Aerosol Therapy through Space and Time].

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

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http://dx.doi.org/10.1055/a-0960-6519DOI Listing
December 2019
5 Reads

Comment on "Optimizing the Delivery of Inhaled Medication for Respiratory Patients: The Role of Valved Holding Chambers".

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

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

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http://dx.doi.org/10.1155/2019/6475651DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6683793PMC
August 2019
9 Reads

Metered-dose inhaler therapy with spacers: Are newborns capable of using this system correctly?

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

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http://dx.doi.org/10.1002/ppul.24436DOI Listing
September 2019
3 Reads

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

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

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http://dx.doi.org/10.1002/ppul.24425DOI Listing
September 2019
5 Reads

Salbutamol and ipratropium by inhaler is superior to nebulizer in children with severe acute asthma exacerbation: Randomized clinical trial.

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

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http://dx.doi.org/10.1002/ppul.24244DOI Listing
April 2019
4 Reads

Usefulness of Nonvalved Spacers for Administration of Inhaled Steroids in Young Children with Recurrent Wheezing and Risk Factors for Asthma.

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

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http://dx.doi.org/10.1155/2018/3095647DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6140101PMC
April 2019
11 Reads

Efficient Nose-to-Lung Aerosol Delivery with an Inline DPI Requiring Low Actuation Air Volume.

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

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http://dx.doi.org/10.1007/s11095-018-2473-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7253151PMC
August 2018
9 Reads

Performance of Large Spacer Versus Nebulizer T-Piece in Single-Limb Noninvasive Ventilation.

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

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http://dx.doi.org/10.4187/respcare.05976DOI Listing
November 2018
13 Reads

Effect of a spacer on total systemic and lung bioavailability in healthy volunteers and in vitro performance of the Symbicort (budesonide/formoterol) pressurized metered dose inhaler.

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

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http://dx.doi.org/10.1016/j.pupt.2018.08.001DOI Listing
October 2018
17 Reads

Optimizing the Delivery of Inhaled Medication for Respiratory Patients: The Role of Valved Holding Chambers.

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

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http://dx.doi.org/10.1155/2018/5076259DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5904796PMC
April 2019
9 Reads

Effect of a Nebulizer Holding Chamber on Aerosol Delivery.

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

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http://dx.doi.org/10.4187/respcare.06061DOI Listing
September 2018
19 Reads
1.840 Impact Factor

Application of an inline dry powder inhaler to deliver high dose pharmaceutical aerosols during low flow nasal cannula therapy.

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

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http://dx.doi.org/10.1016/j.ijpharm.2018.05.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7253153PMC
July 2018
10 Reads

Randomized study of the effects of Aerochamber Plus Flow-Vu on the efficacy, pharmacokinetics and safety of glycopyrronium/formoterol fumarate dihydrate metered dose inhaler in patients with chronic obstructive pulmonary disease.

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

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https://linkinghub.elsevier.com/retrieve/pii/S09546111183010
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http://dx.doi.org/10.1016/j.rmed.2018.03.033DOI Listing
May 2018
46 Reads

Misuse of inhalers among COPD patients in a community hospital in Taiwan.

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

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http://dx.doi.org/10.2147/COPD.S158864DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5922420PMC
October 2018
12 Reads

In vitro and clinical characterization of the valved holding chamber AeroChamber Plus Flow-Vu for administrating tiotropium Respimat in 1-5-year-old children with persistent asthmatic symptoms.

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

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http://dx.doi.org/10.1016/j.rmed.2018.03.010DOI Listing
April 2018
14 Reads
3.090 Impact Factor

Use of spacers for patients treated with pressurized metered dose inhalers: focus on the VENTOLIN™ Mini Spacer.

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

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http://dx.doi.org/10.1080/17425247.2018.1437414DOI Listing
April 2018
17 Reads

A review of the in vitro and in vivo valved holding chamber (VHC) literature with a focus on the AeroChamber Plus Flow-Vu Anti-static VHC.

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

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http://dx.doi.org/10.1177/1753465817751346DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5937155PMC
January 2019
22 Reads

Improving treatment of asthma attacks in children.

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.

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http://dx.doi.org/10.1136/bmj.j5763DOI Listing
December 2017
14 Reads

Are valved holding chambers (VHCs) interchangeable? An in vitro evaluation of VHC equivalence.

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

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http://dx.doi.org/10.1016/j.pupt.2017.10.005DOI Listing
February 2018
20 Reads

Use of a disposable valved-holding chamber (spacer) in a school-based asthma trial.

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.

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http://dx.doi.org/10.1016/j.jaip.2017.08.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5760365PMC
October 2019
9 Reads

Development of an Intelligent Spacer Data Logger System.

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

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http://www.liebertpub.com/doi/10.1089/jamp.2017.1375
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http://dx.doi.org/10.1089/jamp.2017.1375DOI Listing
December 2017
32 Reads

Valved Holding Chambers and In Vitro Metered Dose Inhaler Performance: Effects of Flow Rate and Inhalation Delay.

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

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http://dx.doi.org/10.1089/jamp.2015.1283DOI Listing
December 2017
21 Reads

[Spacer, Aerosol Therapy through Space and Time].

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

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http://dx.doi.org/10.1055/s-0043-109628DOI Listing
July 2017
51 Reads

Investigation of multiphase multicomponent aerosol flow dictating pMDI-spacer interactions.

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

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http://dx.doi.org/10.1016/j.ijpharm.2017.07.005DOI Listing
August 2017
135 Reads

Inhaled salbutamol dose delivered by jet nebulizer, vibrating mesh nebulizer and metered dose inhaler with spacer during invasive mechanical ventilation.

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

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http://dx.doi.org/10.1016/j.pupt.2017.06.004DOI Listing
August 2017
79 Reads

#Asthma #Inhaler: Evaluation of visual social media depictions of inhalers and spacers.

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:

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http://dx.doi.org/10.1016/j.jaip.2017.04.029DOI Listing
August 2019
4 Reads

Home-made spacer as an auxiliary device in administration of beclomethasone via pressurized metered dose inhaler for asthma control. A randomized controlled pragmatic trial.

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

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http://dx.doi.org/10.1016/j.rmed.2017.03.017DOI Listing
May 2017
55 Reads

Effect of Spacers on the Bipolar Electrostatic Charge Properties of Metered Dose Inhaler Aerosols-A Case Study With Tilade.

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

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http://dx.doi.org/10.1016/j.xphs.2017.02.014DOI Listing
June 2017
32 Reads

Real-Life Outcomes for Patients with Asthma Prescribed Spacers for Use with Either Extrafine- or Fine-Particle Inhaled Corticosteroids.

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

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https://linkinghub.elsevier.com/retrieve/pii/S22132198163058
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http://dx.doi.org/10.1016/j.jaip.2016.11.026DOI Listing
January 2018
112 Reads

Drug Delivery in Asthmatic Children Following Coordinated and Uncoordinated Inhalation Maneuvers: A Randomized Crossover Trial.

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

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http://dx.doi.org/10.1089/jamp.2016.1337DOI Listing
June 2017
39 Reads

[Health care providers' knowledge and abilities to use inhalation devices and spacers].

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

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http://dx.doi.org/10.1016/j.rmr.2016.08.005DOI Listing
May 2017
15 Reads

SPECT-CT Comparison of Lung Deposition using a System combining a Vibrating-mesh Nebulizer with a Valved Holding Chamber and a Conventional Jet Nebulizer: a Randomized Cross-over Study.

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

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http://dx.doi.org/10.1007/s11095-016-2061-7DOI Listing
February 2017
93 Reads

Improving Resident Knowledge of Spacers.

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

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http://dx.doi.org/10.1177/0009922816664405DOI Listing
October 2016
77 Reads

The effect of a holding chamber on albuterol metered-dose inhaler product differences.

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

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http://dx.doi.org/10.1016/j.anai.2016.07.016DOI Listing
September 2016
37 Reads

Factors affecting the efficiency of aerosolized salbutamol delivery via a metered dose inhaler and equine spacer device.

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

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http://dx.doi.org/10.1111/jvp.12354DOI Listing
June 2017
22 Reads

Bronchodilators delivered by nebuliser versus pMDI with spacer or DPI for exacerbations of COPD.

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

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http://dx.doi.org/10.1002/14651858.CD011826.pub2DOI Listing
August 2016
58 Reads

Dilemmas, Confusion, and Misconceptions Related to Small Airways Directed Therapy.

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

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http://dx.doi.org/10.1016/j.chest.2016.07.035DOI Listing
June 2017
16 Reads

A Cost Analysis of Salbutamol Administration by Metered-Dose Inhalers with Spacers versus Nebulization for Patients with Wheeze in the Pediatric Emergency Department: Evidence from Observational Data in Nova Scotia.

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

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http://dx.doi.org/10.1017/cem.2016.344DOI Listing
January 2017
44 Reads

Metered dose inhaler-spacer use education effects on achieve asthma control in children.

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

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http://dx.doi.org/10.5578/tt.9142DOI Listing
June 2016
33 Reads

MDI with DIY Spacer versus Nebulizer for Bronchodilator Therapy in Children Admitted with Asthmatic Attack.

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

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July 2016
11 Reads

A systematic review of instruments aimed at evaluating metered-dose inhaler administration technique in children.

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

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http://dx.doi.org/10.1080/02770903.2016.1198373DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5542566PMC
March 2017
25 Reads

Pressurised metered dose inhaler-spacer technique in young children improves with video instruction.

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

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http://dx.doi.org/10.1007/s00431-016-2738-2DOI Listing
July 2016
106 Reads

Nonuniform Deposition of Pressurized Metered-Dose Aerosol in Spacer Devices.

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

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http://dx.doi.org/10.1089/jamp.2015.1257DOI Listing
December 2016
100 Reads

Enhancing Asthma Medication Delivery: Spacers and Valved Holding Chambers.

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

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http://dx.doi.org/10.1177/1942602X16646593DOI Listing
July 2016
15 Reads

Spacers versus nebulizers in treatment of acute asthma - a prospective randomized study in preschool children.

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

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http://dx.doi.org/10.1080/02770903.2016.1185114DOI Listing
December 2016
29 Reads

[Bench-test evaluation of spacer devices for fluticasone delivery to infants].

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

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http://dx.doi.org/10.1016/j.rmr.2016.02.009DOI Listing
January 2017
16 Reads

Inhaler Technique in Children With Asthma: A Systematic Review.

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

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https://linkinghub.elsevier.com/retrieve/pii/S18762859163013
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http://dx.doi.org/10.1016/j.acap.2016.04.006DOI Listing
June 2017
58 Reads

Oronasal and Tracheostomy Delivery of Soft Mist and Pressurized Metered-Dose Inhalers With Valved Holding Chamber.

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

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http://dx.doi.org/10.4187/respcare.04575DOI Listing
July 2016
21 Reads

Systemic Exposures of Fluticasone Propionate and Salmeterol Following Inhalation via Metered Dose Inhaler with the Mini Spacer Compared with the Aerochamber Plus Spacer.

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

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http://dx.doi.org/10.1089/jamp.2015.1236DOI Listing
August 2016
60 Reads