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At least 19 recordsLinked to original sources
PubMed2006

Spacer inhalation technique and deposition of extrafine aerosol in asthmatic children.

The aim of the present study was to measure airway, oropharyngeal and gastrointestinal deposition of (99m)Tc-labelled hydrofluoroalkane-beclomethasone dipropionate after inhalation via a pressurised metered-dose inhaler and spacer (Aerochamber Plus) in asthmatic children. A group of 24 children (aged 5-17 yrs) with mild asthma inhaled the labelled drug. A total of 12 children took five tidal breaths after each actuation (tidal group). The other 12 children used a slow maximal inhalation followed by a 5 - 10-s breath-hold (breath-hold group). Simultaneous anterior and posterior planar gamma-scintigraphic scans (120-s acquisition) were recorded. For the tidal group, mean+/-sd lung deposition (% ex-actuator, attenuation corrected) was 35.4+/-18.3, 47.5+/-13.0 and 54.9+/-11.2 in patients aged 5-7 (n = 4), 8-10 (n = 4) and 11-17 yrs (n = 4), respectively. Oropharyngeal and gastrointestinal deposition was 24.0+/-10.5, 10.3+/-4.4 and 10.1+/-6.2. With the breath-hold technique, lung deposition was 58.1+/-6.7, 56.6+/-5.2 and 58.4+/-9.2. Oropharyngeal and gastrointestinal deposition was 12.9+/-3.2, 20.1+/-9.5 and 20.8+/-8.8. Inhalation of the extrafine formulation with the breath-hold technique showed significantly improved lung deposition compared with tidal breathing across all ages. Oropharyngeal and gastrointestinal deposition was markedly decreased, regardless of which inhalation technique was applied, compared with a previous paediatric study using the same formulation delivered via a breath-actuated metered-dose inhaler.

Administration, Inhalation↗
PubMed2005

Randomized controlled trial of salbutamol aerosol therapy via metered dose inhaler-spacer vs. jet nebulizer in young children with wheezing.

The jet nebulizer is a common device used for administering aerosol medication in young children. However, compared to a metered dose inhaler-spacer (MDI-spacer), it takes more time and personnel. This study aimed to compare the efficacy of salbutamol aerosol therapy given via these two devices in young wheezing children. A prospective randomized, double-blind, placebo-controlled trial was performed in children up to 5 years old who had acute wheezing and were admitted to the Department of Pediatrics, King Chulalongkorn Memorial Hospital. Patients were randomly divided into two groups. The first group received 2 puffs of placebo via MDI-spacer, followed by 0.15 mg/kg salbutamol respiratory solution via jet nebulizer. The second group received 2 puffs (100 microg/puff) of salbutamol via MDI-spacer, followed by placebo via jet nebulizer. Clinical scores and tidal breathing pulmonary function test were evaluated before and after treatment. Pulmonary function parameters included those derived from flow volume loops (volume to peak tidal expiratory flow over total expiratory volume, V(PTEF)/V(E); time to peak tidal expiratory flow over total expiratory time, T(PTEF)/T(E); and ratio of tidal expiratory flow at 25% remaining expiration to peak expiratory flow, 25/PF), compliance (Crs), and resistance (Rrs) of the respiratory system. The efficacy of both methods was compared by using analysis of covariance. Forty-seven wheezing children were studied (24 received salbutamol via MDI-spacer, and 23 received it via jet nebulizer). There was no statistical difference between the two groups regarding clinical scores and all pulmonary function parameters. However, heart rate was significantly increased after treatment in the jet nebulizer group when compared to those in the MDI-spacer group (P = 0.004). In conclusion, the efficacy of salbutamol aerosol therapy via MDI-spacer compared to jet nebulizer in young wheezing children was not different in terms of clinical score and postbronchodilator pulmonary function parameters. However, salbutamol aerosol therapy via jet nebulizer significantly increased the heart rate when compared to the MDI-spacer.

Aerosols↗
PubMed2006

Aerosol therapy by pressured metered-dose inhaler-spacer in sleeping young children: to do or not to do?

UNLABELLED: One third of young children are distressed during inhalation therapy. It has been suggested that administration during sleep could be a good alternative for these children. A laboratory study in our department using an infant upper airway model showed significantly higher lung doses from a pressured metered-dose inhaler (pMDI)-spacer for sleep-breathing patterns compared with wake-breathing patterns. OBJECTIVE: We set up a daily life study to investigate the feasibility of aerosol administration by means of pMDI-spacer in sleeping young children. DESIGN: Over a period of 3 weeks, 30 children (age range, 6 to 23 months) with recurrent wheeze daily inhaled 1 puff of budesonide aerosol (200 mug) while awake and 1 puff during sleep. Filters positioned between the chamber and the facemask trapped the budesonide aerosol. Parents scored the child's asthma symptoms, degree of cooperation, and feasibility of administration on diary cards. RESULTS: In 69% of the sleep administrations, the children woke up, and in 75% of these cases the children were distressed. The mean filter dose (expressed as the percentage of the nominal dose) while awake was 47%, and during sleep it was 16% (p = 0.007). The median within-subject dose variability while awake was 50%, and during sleep it was 110% (p = 0.007). CONCLUSION: Aerosol administration by means of pMDI-spacer during sleep offers no advantage and is not a feasible treatment option in most young children.

Administration, Inhalation↗
PubMed2000

Gender differences in metered-dose inhaler-spacer device technique.

STUDY OBJECTIVE: To determine whether gender affects the correct use of a metered-dose inhaler (MDI)-spacer device. DESIGN: Prospective, observational study. SETTING: University classrooms. PATIENTS: Eighty-three students in their third year of a Doctor of Pharmacy program. INTERVENTION: Students were given the device and received 20 minutes of education on its use. They then were asked to perform the technique. Assessment and retraining were done, as necessary, by clinicians who were experienced with the device. Students returned 1 week later to perform the technique again. MEASUREMENTS AND MAIN RESULTS: The performance of men versus women was analyzed with chi 2 tests and the Student's t test. Power analysis indicated that 30 students were needed in each group. CONCLUSION: There were no significant differences between men and women in proper MDI-spacer technique.

Adult↗
PubMedDate not supplied

Water accumulation in metered dose inhaler spacers under normal mechanical ventilation conditions.

OBJECTIVE: The purpose of this study was to compare the water accumulation in 3 types of metered dose inhaler (MDI) spacer shapes in-line in a ventilator circuit, in 2 positions over 2-, 4-, and 6-hour time periods through the use of heated- and nonheated-wire ventilator circuits. DESIGN: The study design was prospective, quasiexperimental, and random assignment. SETTING: The study was conducted in a university laboratory. MATERIALS: Three brands of MDI spacers (OptiVent, ACE, AeroVent) were tested. OUTCOME MEASURES: Grams of water accumulation were measured. INTERVENTION: Distilled water accumulation was measured in 3 brands of MDI spacers in 0 degrees and 45 degrees positions at 2-, 4-, and 6-hour time intervals. Water accumulation was measured in each spacer by calculating the differences between pretest (dry) weights and posttest (wet) weights through the use of an analytical balance. A Marquest SCT-3000 servo-controlled humidifier with heated-wire ventilator circuit was used with a room temperature range of 21.7 degrees C-22.8 degrees C (71 degrees -73 degrees F) and a relative humidity range of 57%-65%. RESULTS: Multivariate repeated measures analysis demonstrated a difference between brands (P <.001). The amount of water accumulated during 6 hours (time variable) was significantly different (P <.001), as was the interaction between time and "spacer brand" (with Greenhouse-Geisser adjustment). The interaction of time and position was also significantly different (P =.001). Water accumulations at a 45 degrees angle were: AeroVent 0.765 +/- 0.152 g; OptiVent 1.894 +/- 0.228 g; and ACE 4.043 +/- 0.665 g through 6 hours of use. CONCLUSIONS: We found that water accumulation was a result of the type of spacer, position of the spacer, and time that the spacer was left in-line. All 3 brands of spacer collected less than 5 mL of water over 6 hours in either position. Heated-wire circuits accumulated less water than nonheated-wire circuits and may be safer when using MDI spacers.

Equipment Design↗
PubMed2001

A prospective controlled trial of albuterol aerosol delivered via metered dose inhaler-spacer device (MDI) versus jet nebulizer in ventilated preterm neonates.

The objective of this study was to identify the most efficient and cost-effective nebulizer device for delivery of albuterol aerosol as a bronchodilator in ventilated preterm infants. Bronchodilators are frequently used as part of the therapeutic regimen of ventilated preterm infants. This can be delivered by different types of nebulizers like the Jet or metered dose inhaler (MDI) spacer device. Fifty-three premature infants being ventilated for RDS (24 to 34 weeks of gestation) were studied just prior to extubation. Twenty-four of them received standard doses of albuterol aerosol via Jet nebulizer and 29 via MDI-spacer. Heart rate, respiratory rate, oxygen saturation, lung compliance, and airway resistance were monitored prior and 15 minutes after albuterol delivery. There were significant changes in the parameters studied between pre- and postnebulizer treatment. In both groups, there was a significant improvement in lung function as evidenced by 13-24% decreased airway resistance (RAWE) and 3-7% increased lung compliance (CDYN). There was also a beneficial clinical response as demonstrated by increased oxygen saturations. These findings suggest that both MDI-spacer and Jet nebulizer are equally effective in delivering the albuterol aerosol to the lower respiratory tract. Since a small dose of albuterol delivered via the MDI-spacer improved lung function as effectively as a higher dose via the Jet nebulizer, the MDI-spacer would be the preferred mode of aerosol administration, especially because it takes only 2 minutes to deliver it. Furthermore, it was also cost-effective as one MDI-spacer treatment costs 2 cents, while a Jet treatment costs 10 cents in our neonatal intensive care unit (NICU).

Administration, Inhalation↗
PubMed1995

[Functional contribution of inhalation spacers in the treatment of asthma].

The aim of this study is to evaluate the ventilatory gain obtained by using metered dose inhaler (MDI) plus spacer versus MDI alone in 30 asthmatic patients (19 men and 11 women); aged 30 to 70 years old. Initial spirometry showed air flow obstruction. A reversibility test was performed with beta 2 agonists: first with MDI and then, later, with MDI plus spacer. In 27 cases (90%) the improvement of FEVI, referring to its initial value, was significantly better with spacer. This improvement was equal or superior to 20% in 19 patients with spacer versus only 9 patients with MDI. The improvement of FEVI was always better with spacer which ever the ways of expressing the bronchodilating response (referring to initial, predicted or absolute value). in conclusion, since the treatment of asthma is now based on local administration of medications, it is recommended to use spacers not only for children and patients who have coordination problems but more widely specially in severe asthma.

Adult↗
PubMed2001

[Inhalation spacer devices in childhood asthma: is utilization easy?].

IMPROVED DRUG DELIVERY: Spacer devices improve the pulmonary deposition of drugs delivered from pressurized metered-dose inhalers because they decrease the diameter of the aerosol particles. Spacer devices are the best delivery system of inhaled drugs in children younger than 8 years. TECHNICAL ASPECTS: Small volume spacer devices, with inspiratory and expiratory valves, are particularly interesting to use. The use of a facemask is only recommended in the youngest and the oldest have to breathe through the mouth piece. Electrostatism is generated from the plastic walls of the spacer devices and decreases the drug delivery. Using a metallic spacer device or washing a plastic spacer device with a domestic detergent, without rinsing with water nor rubbing the walls, avoids this problem. OPTIMAL USE: Spacer devices are not generics. Each drug has a specific behaviour in a spacer device. Correct inhalatory technique has to be checked at each visit for an optimal efficacy of the treatment.

Administration, Inhalation↗
PubMed1992

An evaluation of MDI (metered dose inhaler) spacers and adapters: their effect on the respirable volume of medication.

The use of a metered dose inhaler (MDI) with an adapter or spacer designed to deliver medication to ventilated patients has been found to produce effects similar to those achieved with small volume nebulizers. For 9 commonly used MDI adapters or spacers, we measured and compared their production of available respirable volume (ARV) of medication. A simulated ventilator circuit was configured to determine ARV as measured by a laser particle-size counter. The adapters or spacers were grouped in three categories: chamber, in-line, and elbow styles. The devices were actuated into the circuit, and ARV was measured 36 separate times with various combinations of medication and medication canister. We found significant differences in ARV between devices, device categories, and medications as compared by ANOVA testing. In this study, chamber-style MDI devices produced greater respirable volume than the in-line- or the elbow-style devices. Of the chamber-style devices, the cone-shaped chamber device provided more respirable volume than did the other two chamber devices. We also found differences among the medications, although we did not anticipate such differences. The possible factors to explain medication differences were not investigated in this study. Because ARV differs according to the design of the individual device used, the choice of device may alter the respirable volume of the medication delivered and, therefore, the effectiveness of the prescribed medication. We conclude that to achieve the desired effects of the medication, practitioners may need to customize the number of MDI actuations according to the device in use.

Administration, Inhalation↗
PubMed1991

Comparison of a hand-held nebulizer with a metered dose inhaler-spacer combination in acute obstructive pulmonary disease.

This study compared the effect of "standard" dose metaproterenol delivered by hand-held nebulizer (HHN) with two puffs of metaproterenol delivered by a metered dose inhaler (MDI) via a spacer (InspirEase) (MDI-spacer). Seventeen patients with an acute exacerbation of obstructive pulmonary disease were studied. Each patient received both MDI-spacer and HHN. Alternate patients were randomized to either MDI-spacer or HHN as initial treatment. Each subject was tested four different times: before and 30 minutes after the initial aerosol delivery technique, and before and 30 minutes after the alternate aerosol delivery technique. Testing consisted of spirometry, lung auscultation, and measurement of vital signs. The interval between treatments for all subjects was 2.96 +/- 0.27 hours (mean +/- SEM) and was not different for subjects who received therapy via MDI-spacer first or HHN first. The patient population studied demonstrated severe airways obstruction (baseline FEV1 33.3 percent predicted +/- 4.9 percent). There was a statistically significant improvement in FVC and FEV1 after metaproterenol delivered by HHN, but not after MDI-spacer. Metaproterenol treatment with HHN resulted in a greater improvement in FEV1 (p less than .05) than MDI-spacer when the data were reported as absolute improvement (0.19 +/- 0.05 L for HHN) vs (0.06 +/- 0.03 L for MDI-spacer) or reported as percent change (23.2 +/- 6.6 percent for HHN) vs (9.5 +/- 3.4 percent for MDI-spacer). Asthmatic patients exhibited a significantly greater (p less than 0.05) improvement in FEV1 after HHN (23.4 +/- 4.7 percent change) than after MDI-spacer (6.6 +/- 4.5 percent change). Patients with chronic obstructive pulmonary disease (COPD) exhibited a greater improvement in FVC (p less than 0.05) after HHN (25.2 +/- 6.7 percent change) than after MDI-spacer (5.8 +/- 4.7 percent change). We conclude that the "standard" dosage of metaproterenol delivered by HHN results in greater spirometric improvement in patients with acute obstructive pulmonary disease than the conventional dosage of metaproterenol delivered by MDI-spacer. It is likely that this reflects the fact that the recommended dose of metaproterenol delivered by MDI is too low and should be increased.

Acute Disease↗
PubMedDate not supplied

Bronchodilator response with use of OptiVent versus Aerosol Cloud Enhancer metered-dose inhaler spacers in patients receiving ventilatory assistance.

OBJECTIVE: This study compared the clinical effectiveness of the OptiVent (HealthScan Products, Inc, Cedar Grove, NJ) and the ACE (DHD, Inc, Canastota, NY) metered dose inhaler (MDI) in-line spacers. DESIGN: Two-group, split-plot design with subjects serving as their own controls. SETTING: Data were collected in a 1000-bed urban hospital. PATIENTS: A convenience sample of 7 intubated patients receiving mechanical ventilation. INTERVENTION: Patients received 4 and 8 puffs of albuterol with use of both the OptiVent and ACE devices. RESULTS: Changes in expiratory airway resistance (Raw), passive peak expiratory flow rate (PEFR), and total work-of-breathing (WOBTOT) were determined using a Bicore monitor (Bicore Monitoring System; Irvine, Calif). With the ACE, Raw decreased an average of 20.2% and 8.8% in patients receiving 4 and 8 puffs, respectively. With the OptiVent, Raw decreased an average of 34.6% and 10.8% in patients receiving 4 and 8 puffs, respectively. Improvements in WOBTOT were less than those seen in Raw, and PEFR did not trend with the other 2 variables. The performances of the 2 spacer brands were comparable, with no statistical difference (P values > 0.05) for all 3 variables with use of the nonparametric Kolmogorov-Smirnov test. CONCLUSIONS: These data suggest that use of the OptiVent spacer yields comparable clinical results with the ACE spacer in patients receiving mechanical ventilation and merits further evaluation.

Administration, Inhalation↗
PubMed1986

Spacer inhalers.

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Administration, Intranasal↗
PubMed2004

Metered dose inhaler with spacer versus dry powder inhaler for delivery of salbutamol in acute exacerbations of asthma: a randomized controlled trial.

BACKGROUND: Delivery of various drugs by aerosol inhalation is the mainstay of treatment of asthma. Many delivery systems have been developed for children, each having its own advantages and disadvantages. Studies comparing the clinical efficacy of metered dose inhalers (MDI) and dry powder inhalers (DPI) in the treatment of acute exacerbations of asthma in children are limited. We conducted a study to compare the response to salbutamol inhalation delivered by metered dose inhaler with a spacer versus rotahaler (DPI) in children presenting with mild or moderate acute exacerbations of asthma. METHODS: Children in the age group of 5-15 years who presented with a mild or moderate acute exacerbation of asthma were randomized to receive 400 micrograms salbutamol by either a MDI with spacer or a DPI. The changes in the wheezing and accessory muscle scores, SaO2, and PEFR were recorded and subjected to statistical tests for significance. RESULTS: One hundred and fifty three children were studied; 78 were assigned to the MDI-spacer group and 75 to rotahaler (DPI) group. After receiving treatment, the PEFR improved by about 11% in both the groups. The oxygen saturation increased by 2% in both the groups. Within each group, the improvement in PEFR, SaO2, wheeze and accessory muscle score after the treatment was statistically significant. In both the groups the children co-operated equally well. CONCLUSION: Metered dose inhaler with spacer and dry powder inhaler have equal efficacy in delivering salbutamol in therapy of mild to moderate acute exacerbations of bronchial asthma in children between 5-15 years of age.

Acute Disease↗
PubMed2004

Spacer devices for metered dose inhalers.

Spacer devices are attachments to the mouthpieces of pressurised metered dose inhalers (pMDIs), and range from tube spacers with a volume of <50 mL to holding chambers with a volume of 750 mL. Compared with a pMDI alone, spacers minimise coordination difficulties, reduce oropharyngeal deposition and often increase lung deposition. Spacers may not improve the clinical effect in patients able to use a pMDI properly, but may allow maintenance dosages of bronchodilators and corticosteroids to be reduced. Correct use of spacer devices is important, especially achieving control over electrostatic charge accumulation on the walls of plastic devices. In patients with severe acute asthma or severe chronic obstructive pulmonary disease, a pMDI plus large volume spacer may be a viable alternative to a nebuliser for delivering large bronchodilator doses. Although the addition of a spacer to every pMDI would not be justified, the use of large volume spacers has been recommended for any inhaled asthma drug in young children, and as a means of reducing systemic bioavailability of inhaled corticosteroids in adults and children alike.

Administration, Inhalation↗
PubMed1999

Comparison of the bronchodilator effects of salbutamol delivered via a metered-dose inhaler with spacer, a dry-powder inhaler, and a jet nebulizer in patients with chronic obstructive pulmonary disease.

The aim of this study was to compare the bronchodilator effects of salbutamol delivered via three different devices: a dry-powder inhaler (DPI), a metered-dose inhaler (MDI) with a large-volume spacer and a jet nebulizer (NEB) in patients with stable chronic obstructive pulmonary disease (COPD). Ten male patients with stable COPD [age: 67.2 +/- 3.8 years, forced expiratory volume in 1 s (FEV1): 1.56 +/- 0.32 liters] were studied in a randomized, double-blind and crossover manner. Each patient received 200 or 1, 000 microg salbutamol via an MDI with an InspirEaseTM spacer, a RotahalerTM, or a DeVilbiss 646(TM) nebulizer (NEB), or matching placebo on 7 separate days. Spirometry was performed before and 15, 30, 60, 90, 120, and 240 min after inhalation. With the 200- microg dose, only DPI produced a small but greater response in maximum FEV1 and in area under the time-response curve (AUC-FEV1) compared with placebo. With the 1,000- microg dose, DPI and MDI produced equally greater improvements in both maximum FEV1 and AUC-FEV1 than NEB. An equal bronchodilating effect can be obtained using either DPI or MDI with a spacer device, whereas the NEB was less effective when the same dose was administered.

Administration, Inhalation↗
PubMed1993

Evaluation of a new spacer device for drug inhalation.

We have studied the efficacy and acceptability of a new inhalation spacer device. The functional principle of the device, differing from that of conventional spacers, is based on evaporation of the propellant during circular movement of the aerosol in a small spherical chamber. We assessed the bronchodilating effect of salbutamol (Salbuvent) inhaled with the new spacer (Rondo) compared with salbutamol (Ventoline) inhaled with the spacer Volumatic and with salbutamol (Salbuvent) inhaled with a conventional metered dose actuator using a double-blind cross-over arrangement. Fifteen asthmatic patients were treated over a period of 4 weeks. They used each of the three different devices for 2-3 days every week. Peak expiratory flow rates were recorded every morning after one and after two puffs of the study drugs. The bronchodilator responses to the three treatments were similar within narrow ranges of estimate. By visual analogue scale assessment the new spacer was significantly easier to handle (P < 0.05) and more convenient to carry around (P < 0.01) than Volumatic.

Adult↗