Abstract
BACKGROUND--It is common for inhaled steroids to be delivered through a large volume spacer device. Comparatively little is known about how this practice affects the dose of drug received by patients compared with drug delivered directly from a metered dose inhaler. METHODS--The amount of beclomethasone dipropionate, contained in particles of various size, available for inhalation from a 750 ml polycarbonate spacer (Volumatic) was determined by impinger measurement and high performance liquid chromatography. Three strengths of metered dose inhalers were studied (50 micrograms, 100 micrograms, and 250 micrograms/actuation). The effect of multiple actuations of beclomethasone dipropionate into a Volumatic spacer, and increasing residence times of drug within the spacer before inhalation, on the amount of drug available to the patient for inhalation was determined. RESULTS--The amount of beclomethasone dipropionate in particles < 5 microns when delivered by a spacer device or directly from a metered dose inhaler was similar. The total amount of beclomethasone dipropionate available for inhalation per actuation decreased by 20 micrograms with the 50 micrograms inhaler, 48 micrograms with the 100 micrograms inhaler, and 161 micrograms with the 250 micrograms inhaler, when given via the spacer compared with delivery directly from a metered dose inhaler. There was a progressive decrease in drug available for inhalation per actuation as the number of actuations into the spacer increased, for all strengths of beclomethasone dipropionate tested. A progressive decrease in drug recovered per actuation was also seen with increasing residence times of drug within the spacer before inhalation. CONCLUSIONS--Use of the spacer device significantly reduced the amount of nonrespirable beclomethasone dipropionate available for inhalation. The amount of beclomethasone dipropionate within respirable particles decreased considerably following multiple actuations into the spacer and with increasing residence times within the spacer before inhalation. When given via a spacer device beclomethasone dipropionate should be inhaled immediately after actuation and multiple actuations into the device should be avoided.
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Selected References
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- Brown P. H., Blundell G., Greening A. P., Crompton G. K. Do large volume spacer devices reduce the systemic effects of high dose inhaled corticosteroids? Thorax. 1990 Oct;45(10):736–739. doi: 10.1136/thx.45.10.736. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Farrer M., Francis A. J., Pearce S. J. Morning serum cortisol concentrations after 2 mg inhaled beclomethasone dipropionate in normal subjects: effect of a 750 ml spacing device. Thorax. 1990 Oct;45(10):740–742. doi: 10.1136/thx.45.10.740. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hummel S., Lehtonen L. Comparison of oral-steroid sparing by high-dose and low-dose inhaled steroid in maintenance treatment of severe asthma. Lancet. 1992 Dec 19;340(8834-8835):1483–1487. doi: 10.1016/0140-6736(92)92750-a. [DOI] [PubMed] [Google Scholar]
- Newman S. P., Morén F., Pavia D., Little F., Clarke S. W. Deposition of pressurized suspension aerosols inhaled through extension devices. Am Rev Respir Dis. 1981 Sep;124(3):317–320. doi: 10.1164/arrd.1981.124.3.317. [DOI] [PubMed] [Google Scholar]
- Noble V., Ruggins N. R., Everard M. L., Milner A. D. Inhaled budesonide for chronic wheezing under 18 months of age. Arch Dis Child. 1992 Mar;67(3):285–288. doi: 10.1136/adc.67.3.285. [DOI] [PMC free article] [PubMed] [Google Scholar]
- O'Callaghan C., Lynch J., Cant M., Robertson C. Improvement in sodium cromoglycate delivery from a spacer device by use of an antistatic lining, immediate inhalation, and avoiding multiple actuations of drug. Thorax. 1993 Jun;48(6):603–606. doi: 10.1136/thx.48.6.603. [DOI] [PMC free article] [PubMed] [Google Scholar]
- O'Callaghan C. Particle size of beclomethasone dipropionate produced by two nebulisers and two spacing devices. Thorax. 1990 Feb;45(2):109–111. doi: 10.1136/thx.45.2.109. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Priftis K., Milner A. D., Conway E., Honour J. W. Adrenal function in asthma. Arch Dis Child. 1990 Aug;65(8):838–840. doi: 10.1136/adc.65.8.838. [DOI] [PMC free article] [PubMed] [Google Scholar]