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PubMed1992

Bronchodilating efficacy of an open-spacer device compared to three other spacers.

BACKGROUND: Spacers devices are commonly used in aerosol therapy; however, they are bulky and require regular cleaning. A compact open spacer (OS, Synchroner, Fisons, UK) has been developed to overcome this problem. We compared bronchodilator efficacy associated with its use to efficacy of same dose via three other spacers: Volumatic (Glaxo Laboratories), Nebuhaler (Astra Laboratories), Inspirease (Key Pharmaceuticals). MATERIALS & METHODS: Sixteen asthmatics (greater than 20% reversibility of FEV1) took part in the study. In random order, they used a different device on each of the 4 study days to inhale 2 puffs of a combination aerosol (1 mg reproterol and 2 mg sodium cromoglycate, Aarane). We recorded results of spirometry before and 5, 30, and 60 minutes after bronchodilator inhalation. RESULTS: At each time, we found no significant difference in bronchodilation. CONCLUSION: OS is as efficient as other commonly used spacers to produce bronchodilation resulting from a conventional dose of reproterol.

Administration, Inhalation↗
PubMedDate not supplied

Recent asthma guidelines, what are the implications for patient management?

Recent publications in particular the British Thoracic Society guidelines for the management of adult asthma, recommend that bronchodilators should not be used more than once a day without anti-inflammatory treatment. There have not been any studies to determine what effect the implementation of these recommendations will have on our management of asthmatic patients. In this study 110 asthmatics who were using regular asthma treatment were identified. Thirty eight (34.5%) were using inhaled beta-agonists alone, of whom 11 (29%) required them more than once day for the relief of symptoms. Seventy two (65%) were using an inhaled anti-inflammatory agent plus an inhaled beta-agonist, of whom 38 (53%) were using their inhaled beta-agonist more than once per day. Forty-nine subjects (45%) therefore required a change in their management as their inhaled beta agonist use exceeded once a day. They were subsequently managed according to a treatment protocol based on current asthma guidelines and followed up over a three-month period. Twenty-eight of these (57%) required a change in their current therapy comprising of the addition of or an increased dose of their existing inhaled anti-inflammatory medication. Seventeen (34.6%) did not require a change in their current therapy, rather they required advice re: the proper use of their "preventitive" medication, or the introduction of a large volume spacer device. Four (8%) were on maximum therapy and no further intervention was possible. Forty-one (83.6%) reduced their inhaled beta agonist requirements to once or less per day within the study period.

Adrenergic beta-Agonists↗
PubMed1994

Assessment of an ambulatory care asthma program.

In response to rising asthma morbidity and mortality, numerous comprehensive asthma programs have been developed. However, few studies have examined critically the effectiveness of such programs or the means by which treatment or outcome is altered. To assess the role of a specialized ambulatory asthma care program, we reviewed the interventions recommended to 344 patients referred for the assessment of asthma. A subset of 127 made return visits 6-12 months following their initial assessment, thereby allowing assessment of behavioral and physiological outcomes. At the initial consultation, the recommended medication changes were: inhaled beta-agonists +6% (p < 0.01), inhaled steroids +58% (p < 0.001), intranasal steroids +8% (p < 0.001), dry powdered formulations +13% (p < 0.01), theophylline -7% (p < 0.001). The percentage of patients using spacer devices increased 8% (p < 0.001). Comparing preassessment values to those at a visit at 6-12 months following assessment, a further 25% of patients taking inhaled steroids at the initial assessment had a change to either the dose, device, or frequency of administration. Mean FEV1 improved from 2.41 +/- 0.08 liters at the initial assessment to 2.64 +/- 0.09 liters at the 6-12-month visit (p < 0.001). There was an increase in the number of patients considered mild and not obstructed, with a corresponding decrease in the number considered moderately and severely obstructed (p < 0.05). The number of emergency room visits was reduced by more than 60% (p < 0.001) in patients followed for at least 6 months. We conclude that an ambulatory asthma program marked by increased use of inhaled anti-inflammatory medications and decreased use of theophylline can produce significant decreases in asthma exacerbations requiring hospital care, emergency room care, or systemic steroids while reducing the prevalence and severity of airflow limitation.

Administration, Inhalation↗
PubMed1992

The role of corticosteroids in the management of childhood asthma. The Thoracic Society of Australia and New Zealand.

OBJECTIVE: To formulate recommendations for the role of corticosteroid therapy in the management of childhood asthma. DATA SOURCES: The recommendations are based on a review of the available literature and a variety of review articles on the efficacy and safety of corticosteroid therapy supplemented by personal experience in managing children with asthma. DATA SYNTHESIS: 1. Preventive therapy. Sodium cromoglycate should be considered first-line treatment. Inhaled corticosteroids are indicated in children who fail to achieve control on this therapy or those with severe disease. An initial dosage of 400-600 micrograms/day is recommended with subsequent variation in dosage related to clinical response. Large volume spacers can be used to improve aerosol delivery and minimise side effects. Indications for specialist assessment include: use of inhaled corticosteroids in children under 3 years of age; the requirement for high dose therapy (greater than 600 micrograms/day); or the need for regular oral corticosteroids. 2. Acute severe asthma. Systemic corticosteroid therapy is a valuable adjunct in the treatment of acute severe asthma and can be used safely in the short term. The efficacy of high dose inhaled corticosteroids in the management of acute severe asthma requires further evaluation. The need for systemic corticosteroid therapy signals the need for reassessment of that child's usual maintenance therapy. CONCLUSION: These recommendations are presented as a guide to the use of corticosteroid therapy in childhood asthma. In the individual child, the benefits of therapy need to be weighted against the possible risks, with the aim of maintaining good asthma control with the minimum dose of corticosteroid.

Asthma↗
PubMed2004

Nebulised salbutamol administered during sputum induction improves bronchoprotection in patients with asthma.

BACKGROUND: Inhalation of hypertonic or even isotonic saline during sputum induction may cause bronchospasm in susceptible patients with asthma, despite premedication with 400 microg inhaled salbutamol delivered by pressurised metered dose inhaler (pMDI). The bronchoprotection afforded by additional inhaled salbutamol administered through the ultrasonic nebuliser during sputum induction was investigated. METHODS: Twenty patients with moderate to severe asthma underwent sputum induction by inhaling saline 4.5% (or 0.9% if post-bronchodilation forced expiratory volume in 1 second (FEV1) <65% predicted) for 10 minutes according to two protocols given 1 week apart in random order. At visit A the patients received 400 microg salbutamol administered through a pMDI+spacer 20 minutes before induction while at visit B the premedication was supplemented by 1500 microg nebulised salbutamol inhaled throughout the induction procedure. Both the investigator and the patients were blind to the nebulised solution used. FEV1 was recorded during sputum induction at 1, 3, 5, and 10 minutes. Sputum cell counts and histamine, tryptase and albumin levels in the supernatants were determined. RESULTS: The mean (SE) maximal reduction in FEV1 over the 10 minute period of sputum induction was 11.7 (2.8)% at visit A, which was significantly greater than at visit B (2.6 (1.2)%; mean difference 9% (95% CI 2.7 to 15.4), p<0.01). Total and differential sputum cell counts as well as albumin, tryptase, and histamine levels did not differ between the two visits. CONCLUSION: The addition of inhaled salbutamol through an ultrasonic nebuliser markedly improves bronchoprotection against saline induced bronchoconstriction in patients with moderate to severe asthma undergoing sputum induction without affecting cell counts and inflammatory markers.

Administration, Inhalation↗
PubMed1996

Serum albuterol levels in mechanically ventilated patients and healthy subjects after metered-dose inhaler administration.

In mechanically ventilated patients, systemic blood levels of inhaled drugs reflect absorption from the lower respiratory tract alone since, unlike nonintubated patients, oropharyngeal and gastrointestinal absorption cannot occur. To determine the efficiency of aerosol administration by a metered-dose inhaler (MDI), we measured serum albuterol levels after administration by a MDI and spacer to nine mechanically ventilated patients (10 puffs) and to 10 healthy subjects (six puffs). Serum albuterol levels (+/- SEM) quantitated by high-performance liquid chromatography and electrochemical detection were: 0.09 +/- 0.04 mg/ml/puff at baseline, 0.66 +/- 0.10 at 5 min, 0.98 +/- 0.10 at 10 min, 0.56 +/- 0.08 at 15 min, and 0.37 +/- 0.03 at 30 min in mechanically ventilated patients versus zero at baseline, 0.89 +/- 0.12 at 5 min, 1.27 +/- 0.13 at 10 min, 0.84 +/- 0.09 at 15 min, and 0.53 +/- 0.07 at 30 min in control subjects (p > or = 0.07 at 5, 10, and 30 min; p < or = 0.05 at baseline and at 15 min). Area under the curve (AUC0-30) in the mechanically ventilated patients was 16.8 +/- 1.4 versus 23.4 +/- 1.9 ng/ml/puff x min in control subjects (p = 0.014). In summary, administration of albuterol with a MDI achieved a profile of serum levels in mechanically ventilated patients similar to that in healthy control subjects, but the peak serum level and systemic bioavailability (AUC0-30) were lower in the patients. In conclusion, serum levels reliably assess lower respiratory tract deposition of albuterol, and show that MDIs are more efficient for aerosol delivery in mechanically ventilated patients than was previously reported in studies using radiolabeled aerosols.

Aged↗
PubMed2002

[Efficacy and safety of high doses of beclomethasone dipropionate in patients with bronchial asthma].

AIM: To assess efficiency and safety of high-dose beklometasone dipropionate in patients with bronchial asthma (BA). MATERIAL AND METHODS: The trial included 14 female and 3 male patients with moderate or severe BA (mean age 43.6 years) in declining exacerbation. The patients inhaled beklometasone dipropionate as a dose-adjusted aerosol with built-up spacer (beklojet) in a daily dose 1000-2000 mcg for 8 weeks. Changes in clinical symptoms, life quality (AQLQ) and bronchial permeability (peak flowmetry, FEV1) were registered. Concentration of H2O2 in expired air condensate was measured spectrophotometrically to evaluate activity of airway inflammation. Oral smears were studied mycologically, hydrocortisone in blood plasma was measured with enzyme immunoassay. RESULTS: The treatment produced positive trend in clinical symptoms and quality of life. Bronchial permeability improved since the 7th treatment day. H2O2 significantly fell, hydrocortisone levels and fungal flora did not change significantly. CONCLUSION: Beklometasone dipropionate in high doses for 8 weeks is effective and safe against BA.

Adult↗
PubMed1993

[Modification of nonspecific bronchial hyperreactivity to cold air hyperventilation and carbachol by nedocromil and budesonide].

In a double blind crossover trial we compared the effect of a four week treatment with inhaled nedocromil (4 x 4 mg/d) or budesonide (2 x 400 micrograms/d by spacer) on non-specific bronchial hyperresponsiveness (BHR) to cold air hyperventilation (CHV) and carbachol. 15 persons with clinically mild asthma, who showed a more than 50% decrease in sG(aw) after CHV were randomly allocated to treatment groups. A double dummy technique was applied. Before and after both treatment periods, which were separated by an out wash period of four weeks, BHR to isocapnic cold air hyperventilation and carbachol was determined on two consecutive days. 13 persons completed the study. Maximum percentual drop of sG(aw-) and FEV1-values after CHV, the number of steps of carbachol-provocation carried out to reach a decrease in sGaw of at least 50% and the calculated cumulative breath units (CBU) of carbachol to cause a 50% (20%) decrease in sG(aw) (FEV1) were assessed. Peak-flow values were registered throughout the study. Data were compared by means of Wilcoxon's matched-pairs signed-ranks test. After budesonide most parameter showed a significant decrease of BHR (CHV: sG(aw) p < 0.1; FEV1 p < 0.05; Carbachol: provocation-steps: p < 0.05; CBU: PD50 sG(aw) p < 0.05; PD20 FEV1 p < 0.05). There was no evidence for an influence of nedocromil on BHR (p-values all > 0.2). Comparing both treatments there was a difference in favour of budesonide partly reaching significance at 5% level. Budesonide but not nedocromil treatment showed a significant increase in peak-flow values (morning p < 0.02, evening p < 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Clinical comparisons of inhaler systems: what are the important aspects?

Inhaled medications are the mainstay of asthma treatment. This not only provides the greatest clinical effect in asthmatic patients, but does so with the least systemic side effects. A wide variety of inhaler systems exist, each of which has inherent advantages and disadvantages. These have to be considered when making a choice of inhaler system for a specific clinical circumstance, as no currently available system is ideal in every clinical situation. Three main types of inhaler systems currently exist and, of these, the pressurized metered dose inhalers (pMDIs) and dry powder inhalers (DPIs) are most frequently used. The advantages of pMDIs are their portability, ease of use (in a properly instructed and adequately co-ordinated patient), cheap cost of manufacture, and low inspiratory flow rates needed to achieve adequate drug deposition in the lung. The main disadvantages of pMDIs, such as oropharyngeal deposition of drug and improper use (in an uncoordinated patient), can be minimized by the use of a spacer device. In contrast, DPIs are easy to use (no co-ordination between actuation and inhalation is required by the patient) and portable, and for the DPI, Turbuhaler, are multiple dose and deposit twice the dose of drug in the lung in comparison with pMDIs. Moreover, the side effects, namely bronchoconstriction and cough, associated with the use of pMDIs are minimized or eliminated with the use of Turbuhaler. A potential disadvantage of DPI systems is that patients need to generate inspiratory flow rates of at least 30 L/min to obtain optimal drug delivery. This is, however, feasible in almost all patients, even in those patients with very severe airflow obstruction.

Administration, Inhalation↗
PubMed1986

Simplification of inhalation therapy in asthmatic children. A comparison of two regimes.

In a placebo-controlled double blind cross-over study of 3 X 3 weeks' duration the effectiveness of a new set of simple instructions for the use of spacer aerosols was compared with that of the rather complicated manufacturer's instructions in the daily treatment of 22 children with severe asthma. All children received inhaled budesonide and terbutaline at the lowest dose possible for satisfactory symptom control. Both the simple and complicated regimes were significantly better than placebo (P less than 0.01), but there was no indication that the complicated regime was superior to the simple regime. On the contrary, the children used significantly more rescue terbutaline and experienced more daytime symptoms when treated according to the complicated regime (P less than 0.01). 19 of 21 children who completed the study preferred to use the simple regime (P less than 0.01). It is concluded that instructions for the use of spacer aerosols should be substantially simplified and that conclusions from laboratory studies should be tested in the day-to-day management of asthmatics before these aerosols become widely used.

Adolescent↗
PubMed1981

Deposition of pressurized suspension aerosols inhaled through extension devices.

Only a small fraction of the dose from a pressurized aerosol inhaler reaches the lung, because most is deposited on the upper airways by inertial impaction. We have investigated the effects on aerosol deposition of two spacer devices (a 10-cm tube and a 22-cm cone) by incorporating teflon particles (mass median aerodynamic diameter, 3.2 micrometer) labeled with 99mTc into pressurized canisters. Ten subjects with obstructive airway disease inhaled the aerosol in a controlled manner from a conventional actuator alone or in combination with the tube or the cone. Radioaerosol distribution was measured using a shadowshield whole body counter. Deposition on the conducting airways was significantly improved by both spacers, but alveolar deposition was unchanged. Initial oropharyngeal deposition was reduced by both spacers in all 10 patients. We conclude that the spacer devices may have a role to play in aerosol therapy by increasing drug availability to the lung, while at the same time decreasing unwanted drug deposition in the oropharynx.

Adrenal Cortex Hormones↗
PubMed1996

Efficiency of aerosol medication delivery from a metered dose inhaler versus jet nebulizer in infants with bronchopulmonary dysplasia.

The best means for optimal delivery of drugs into lungs of infants with bronchopulmonary dysplasia (BPD) is uncertain. We aimed to measure radio-aerosol deposition of salbutamol by jet nebulizer and metered dose inhalers (MDI) in ventilated and non-ventilated BPD infants. In a randomized, crossover sequence, salbutamol lung deposition was measured using an MDI (2 puffs or 200 micrograms) or sidestream jet nebulizer (5 minutes of nebulization with 100 micrograms/kg) in 10 ventilated (mean birthweight, 1,101 g) and 13 non-ventilated (mean birthweight, 1,093 g) prematurely born infants. Non-ventilated infants inhaled aerosol through a face mask, connected to a nebulizer or an MDI and spacer (Aerochamber). Ventilated infants received aerosol from an MDI + MV15 Aerochamber or a nebulizer inserted in the ventilator circuit. Lung deposition by both methods was low: mean (SEM) from the MDI was 0.67 (0.17)% of the actuated dose, and from the nebulizer it was 1.74 (0.21)% and 0.28 (0.04)% of the nebulized and initial reservoir doses, respectively. Corresponding figures for the ventilated infants were 0.98 (0.19)% from the MDI and 0.95 (0.23)% and 0.22 (0.08)% from the nebulizer. In both groups, and for both methods of delivery, there was marked inter-subject variability in lung deposition and a tendency for the aerosol to be distributed to the central lung regions.

Aerosols↗
PubMed1998

Beta 2-agonists administered by a dry powder inhaler can be used in acute asthma.

Patients with acute asthma attending the emergency room were included in a double-blind, double-dummy and parallel group study to investigate whether a dry powder inhaler (Turbuhaler) can be used in acute asthma. If so, the aim was to establish the potency relationship between a beta 2-agonist (salbutamol) administered by the dry powder inhaler and the pressurized metered-dose inhaler (pMDI). Eighty-six patients with a mean age of 38 years and forced expiratory volume in 1 s (FEV1) of 37% of predicted normal value were randomized at Siriraj Hospital in Bangkok to either Turbuhaler (50 micrograms dose -1) or pMDI (100 micrograms dose -1) with spacer (Volumatic). Doses of 100 + 300 + 300 + 300 micrograms salbutamol were given at 0, 15, 30 and 45 min via Turbuhaler and repeated at 90, 105, 120 and 135 min (total dose 2000 micrograms). The same inhalation schedule with identical number of doses was used for the pMDI with spacer but in double doses (total 4000 micrograms), assuming a dose-potency ratio of salbutamol administered via Turbuhaler compared with the pMDI of 2:1. At 85 min after the first dose, 60 mg prednisolone was given orally. FEV1 was measured 10 min after each dosing. Peak inspiratory flow (PIF) through Turbuhaler was measured on each dosing occasion. Plasma (P)-salbutamol, serum (S)-potassium concentrations, pulse rate, blood pressure and adverse events were recorded. No statistically significant differences were observed in the increase in FEV1 between the groups: 55 min (165 min) after the first dose, the increase was 0.47 l and 47% (0.64 l and 63%) in the Turbuhaler group, and 0.46 l and 42% (0.68 l and 65%) in the pMDI group. Mean PIF though Turbuhaler was 49 l min -1 (range 26-68) at first inhalation and increased to 60 l min -1 (range 38-86). There was no correlation between the initial PIF through Turbuhaler and the initial FEV1 response. P-salbutamol and S-potassium values correlated well. A larger decrease in S-potassium was noticed after 75 min in the pMDI group (0.38 mmol l -1) compared with the Turbuhaler group (0.23 mmol l -1) (P = 0.02). In conclusion, the use of a dry powder inhaler, Turbuhaler, was investigated in the emergency room treatment of acute asthma, and was as effective as a pMDI with spacer. Half the dose of salbutamol administered via Turbuhaler was as effective as the full dose given via a pMDI with spacer.

Acute Disease↗
PubMed2005

Fluticasone versus HFA-beclomethasone dipropionate for chronic asthma in adults and children.

BACKGROUND: The relative efficacy of fluticasone (FP) and beclomethasone (BDP) propelled with CFCs has been well established. The potency of HFA-BDP is thought to have been improved with new propellant and some studies suggest that it may equipotent at half the dose of CFC propelled-BDP. There is a need to revisit this question in the light of a potentially more potent new non-CFC propellant. OBJECTIVES: To determine the relative efficacy of FP and HFA-propelled BDP in chronic asthma. SEARCH STRATEGY: The Cochrane Airways Group Specialised Register was searched using pre-specified terms. Searches were current as of March 2005. SELECTION CRITERIA: Randomised controlled trials were eligible for inclusion in the review. We compared either CFC or HFA-propelled FP with HFA-propelled BDP. We made a distinction between HFA-BDP and HFA-BDP extra fine, which dispenses smaller particles of drug, leading to different, usually more peripheral distribution in the airways. Any inhaler device was considered, and there was no restriction on studies with or without spacers. We included studies which assessed HFA-BDP given via either pMDI, breath-actuated MDI, or DPI. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed studies for inclusion in the review. Data were extracted and entered in to RevMan 4.2 using standard meta-analytical techniques with predefined criteria for exploring statistical heterogeneity. MAIN RESULTS: Seven studies (1230 participants) met the inclusion criteria of the review. One study was conducted in children. Study reporting quality was fair, but all studies were of short duration (three to twelve weeks). Only studies assessing HFA-BDP extra fine in comparison with FP were identified. Lung function was not significantly different between extra fine BDP and FP when compared at the same dose in parallel studies, change in FEV1: 0.04 litres (95% CI -0.03 to 0.11 litres; three studies, 659 adults); change in am PEF: -0.69 litres (95% CI -11.21 to 9.83 litres; two studies, 364 adults). Individual studies reported non-significant findings in symptom scores and quality of life questionnaires. There was no significant difference between FP and HFA-BDP in the risk of study withdrawal, dysphonia or when data were reported as any adverse event. AUTHORS' CONCLUSIONS: There was no significant difference between FP and extra fine HFA-BDP on FEV(1) or peak flow at a dose ratio of 1:1. However, the number of studies and width of the confidence intervals in the analyses do not exclude a clinically meaningful difference between these two drugs. Difficulty in the successful manipulation of the devices studied may be a barrier to the widespread use of MDIs. One paediatric study was included in the review, so extrapolation of the findings of this review to children is limited. Further longer term studies in adults and children with moderate and severe asthma are required.

Administration, Inhalation↗
PubMed2006

Fluticasone versus HFA-beclomethasone dipropionate for chronic asthma in adults and children.

BACKGROUND: The relative efficacy of fluticasone (FP) and beclomethasone (BDP) propelled with CFCs has been well established. The potency of HFA-BDP is thought to have been improved with new propellant and some studies suggest that it may equipotent at half the dose of CFC propelled-BDP. There is a need to revisit this question in the light of a potentially more potent new non-CFC propellant. OBJECTIVES: To determine the relative efficacy of FP and HFA-propelled BDP in chronic asthma. SEARCH STRATEGY: The Cochrane Airways Group Specialised Register was searched using pre-specified terms. Searches were current as of January 2006. SELECTION CRITERIA: Randomised controlled trials were eligible for inclusion in the review. We compared either CFC or HFA-propelled FP with HFA-propelled BDP. We made a distinction between HFA-BDP and HFA-BDP extra fine, which dispenses smaller particles of drug, leading to different, usually more peripheral distribution in the airways. Any inhaler device was considered, and there was no restriction on studies with or without spacers. We included studies which assessed HFA-BDP given via either pMDI, breath-actuated MDI, or DPI. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed studies for inclusion in the review. Data were extracted and entered in to RevMan 4.2 using standard meta-analytical techniques with predefined criteria for exploring statistical heterogeneity. MAIN RESULTS: Eight studies (1260 participants) met the inclusion criteria of the review. One study was conducted in children. Study reporting quality was fair, but all studies were of short duration (three to twelve weeks). Only studies assessing HFA-BDP extra fine in comparison with FP were identified. Lung function was not significantly different between extra fine BDP and FP when compared at the same dose in parallel studies, change in FEV1: 0.04 litres (95% CI -0.03 to 0.11 litres; three studies, 659 adults); change in am PEF: -0.69 litres (95% CI -11.21 to 9.83 litres; two studies, 364 adults). Individual studies reported non-significant findings in symptom scores and quality of life questionnaires. There was no significant difference between FP and HFA-BDP in the risk of study withdrawal, dysphonia or when data were reported as any adverse event. AUTHORS' CONCLUSIONS: There was no significant difference between FP and extra fine HFA-BDP on FEV(1) or peak flow at a dose ratio of 1:1. However, the number of studies and width of the confidence intervals in the analyses do not exclude a clinically meaningful difference between these two drugs. Difficulty in the successful manipulation of the devices studied may be a barrier to the widespread use of MDIs. One paediatric study was included in the review, so extrapolation of the findings of this review to children is limited. Further longer term studies in adults and children with moderate and severe asthma are required.

Administration, Inhalation↗
PubMed1990

[Distribution and site of action of inhaled aerosols].

Intrapulmonary distribution of nebulized aerosols and sites of air way dilatation following metered-dose aerosol delivery were studied by radionuclide methods. Aerosols penetrate to more peripheral site in slow inhalation and deposition of aerosols in diseased area was enhanced by release at a high lung volume. Pulmonary deposition of radioaerosols released from spacers was over 50% of activity in the spacer. Predominant site of bronchodilatation (beta-stimulant) was on large airways, though action on small airways was also noted.

Administration, Inhalation↗
PubMed1995

Albuterol delivery in a model of mechanical ventilation. Comparison of metered-dose inhaler and nebulizer efficiency.

Using an in vitro model, we compared efficiencies of jet nebulizers and metered-dose inhalers (MDI) with actuator devices to deliver albuterol in various conditions of mechanical ventilation. Factors tested included influence of humidification, MDI actuator device (Aerovent spacer or Marquest 172275 MDI adaptor), and synchronization of MDI to the respiratory cycle. With the nebulizer (AeroTech II) filled with 2.5 mg albuterol sulfate in 3 ml water and run until dry, inhaled mass was 42 +/- 2.6% and mass median aerodynamic diameter (MMAD) was 1.3 microns on a nonhumidified circuit. With the MDI+ Aerovent, the inhaled mass percentage per 90 microgm puff was 15.4 +/- 0.2% with humidification and 25.1 +/- 3.7% without humidification, actuations being synchronized with the beginning of inspiration and separated by a 1-min pause. Failure to synchronize actuations with inspiration or to pause 1 min resulted in significant reductions in inhaled mass (by 35 and 72%, respectively). The Marquest adaptor was less efficient, with an inhaled mass of 7.2 +/- 0.7% under optimal conditions. Metered-dose inhaler actuation during expiration resulted in relatively large particles (MMAD = 2.0 microns). All other MDI actuations led to essentially biphasic distributions, with particles greater than 1 micron following a distribution similar to the nebulizer and the overall MMAD estimated to be 0.22 microns. The AeroTech II delivered a cumulative 1,000 micrograms of drug (2,500 x 0.40) over 40 min. To achieve that amount, the MDI connected to the Aerovent and used in its most efficient sequence would require 45 timed puffs (90 micrograms per puff, 25.1% mean inhaled mass) and take 45 min of an experienced therapist's time.(ABSTRACT TRUNCATED AT 250 WORDS)

Aerosols↗
PubMed1993

Variations in the treatment of childhood asthma.

OBJECTIVE: To survey the assessment and management of childhood asthma by paediatricians, general practitioners, and respiratory physicians, and compare these findings with the Australian and New Zealand Consensus Statement guidelines on asthma management in children. SETTING AND DESIGN: A six-item postal questionnaire designed to cover assessment, management of acute and mild asthma, use of prophylaxis and methods of delivery of medication. PARTICIPANTS: A random sample of 100 paediatricians, 300 general practitioners and 100 respiratory physicians. RESULTS: Response rates were: paediatricians, 88%; general practitioners, 66%; and respiratory physicians 51%. There was agreement between all three groups in most aspects of asthma management. Deviations from the Consensus Statement guidelines included: between 38% and 49% not using oxygen as one of the first-line treatments for acute asthma; a higher use of orally administered beta 2-agonists by general practitioners (up to 40% for children between one and three years compared with 17% of paediatricians and 12% of respiratory physicians); a tendency to use intravenously administered aminophylline before corticosteroids (20% of paediatricians, 40% of general practitioners and 30% of respiratory physicians); a preference among general practitioners and respiratory physicians to prescribe inhaled corticosteroids rather than sodium cromoglycate for prophylaxis in older children; and a low incidence of use of spacer devices in older children. CONCLUSIONS: If currently published recommendations on managing asthma in children are followed, there should be: more education and emphasis on the value of oxygen and short courses of orally administered corticosteroids in acute asthma management; less reliance on intravenously administered aminophylline; decreased use of orally administered beta 2-agonists coupled with a more wide-spread use of spacer devices; and an increased emphasis on sodium cromoglycate as first-line daily prophylaxis.

Acute Disease↗