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Inhaled steroid delivery from small-volume holding chambers depends on age, holding chamber, and interface in

Jean-Christophe Dubus1, Jacob Anhøj

  • 1Unité de Médecine Infantile, CHU Timone-Enfants, Marseille, France. jean-christophe.dubus@ap-hm.fr

Journal of Aerosol Medicine : the Official Journal of the International Society for Aerosols in Medicine
|January 1, 2005
PubMed

Insights

Inhaled steroid delivery via holding chambers significantly increases with patient age. Device choice and inhalation interface (mask vs. mouthpiece) also impact drug delivery for asthma patients.

Area of Science:

  • Respiratory Medicine
  • Pediatric Pulmonology
  • Pharmacology

Background:

  • Pressurized metered-dose inhalers (pMDIs) with holding chambers are common for delivering inhaled corticosteroids (ICS) to children.
  • Optimal drug delivery is crucial for managing pediatric asthma effectively.
  • Factors influencing ICS delivery, such as patient age and device interface, require further investigation.

Purpose of the Study:

  • To investigate the relationship between patient age, holding chamber type, and inhalation interface on the delivery of inhaled steroids from pMDIs.
  • To quantify the amount of inhaled steroid reaching the filter (proxy for lung deposition) across different age groups and device configurations.

Main Methods:

  • An open, randomized, cross-over filter study was conducted with 4 groups of children (infants to adolescents) with varying asthma severity.
  • Budesonide (Nebuchamber) and fluticasone propionate (Babyhaler) were administered via pMDIs with their respective holding chambers.
  • Drug delivery was measured using filters, analyzed by high-performance liquid chromatography, and modeled using mixed-effects linear regression.

Main Results:

  • Inhaled steroid delivery significantly increased with age for both holding chambers, from 3-7% in infants to 40-41% in adolescents.
  • Nebuchamber showed higher drug delivery than Babyhaler (p=0.002).
  • Using a mouthpiece resulted in lower filter doses compared to a facemask for both devices (p<0.0001).

Conclusions:

  • Inhaled steroid delivery from pMDIs with holding chambers is significantly influenced by patient age, holding chamber type, and inhalation interface.
  • These findings highlight the need for age-appropriate device selection and interface use in pediatric asthma management.
  • Further clinical studies are warranted to compare lung deposition and clinical outcomes between mouthpiece and facemask inhalation from holding chambers.

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