Evaluation of Disposable and Traditional Accessory Devices for Use With a Pressurized Metered-Dose Inhaler

The use of accessory devices with pressurized metered-dose inhalers (pMDIs) enhances aerosol delivery and helps overcome any lack of patient coordination when using the pMDI. The use of accessory devices could be influenced by the efficacy, availability, and cost of these devices. The aim of this study was to compare drug delivery with the pMDI alone and with non-antistatic and antistatic accessory devices.

The total emitted dose and aerodynamic characterization of salbutamol particles were measured for the pMDI alone and for the pMDI combined with 4 different accessory devices: a homemade spacer, the Dolphin spacer, the DispozABLE paper spacer, and the AeroChamber Plus valved holding chamber. Aerodynamic characterization was analyzed with an Andersen cascade impactor at an inhalation flow of 28.3 L/min, and drug deposition was measured with high-performance liquid chromatography.

The mean ± SD total emitted dose from the pMDI alone, 155.2 ± 20.5 μg, was the greatest of all modalities, and the difference was significant (P < .001). The homemade and Dolphin spacers had the highest mean ± SD deposited amounts of salbutamol remaining on their walls (ie, 124.1 ± 11.1 μg and 131.5 ± 11.8 μg, respectively). The mean ± SD total emitted doses with the AeroChamber Plus valved holding chamber (61.9 ± 8.9 μg) and the DispozABLE paper spacer (76.4 ± 8.6 μg) were significantly higher than the emitted doses with the other devices. The mean ± SD fine-particle doses emitted with the AeroChamber plus valved holding chamber (51.4 ± 4.7 μg) and the DispozABLE paper spacer (39.7 ± 5.6 μg) were significantly higher than those with the other devices. The AeroChamber Plus valved holding chamber had the lowest mass median aerodynamic diameter (MMAD) values, but there were no statistically significant differences in MMAD between any of the combinations of pMDI and accessory device.

The valved holding chamber and the paper spacer had better aerodynamic characteristics than the other devices tested. We consider the antistatic devices to be the optimum devices for aerosol delivery due to their high efficacy compared to non-antistatic devices.