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Influence of spacer device on drug delivery to young children with asthma
1Department of Paediatrics, Kolding Hospital, Denmark.
Insights
Spacer device volume is less critical for budesonide delivery in infants (10-25 months) than previously thought. Smaller spacers (under 750 ml) effectively deliver medication when used with a facemask.
Area of Science:
- Pediatric Pulmonology
- Respiratory Drug Delivery
- Pharmacokinetics
Background:
- Inhaled corticosteroids like budesonide are crucial for managing pediatric asthma.
- Spacer devices improve medication delivery to the lungs, but optimal device characteristics for infants are debated.
- Budesonide delivery varies significantly between different inhaler devices.
Purpose of the Study:
- To compare the delivered budesonide dose from three different spacer devices in infants aged 10-25 months.
- To assess the impact of spacer volume on budesonide delivery in young children.
- To evaluate the relationship between minute ventilation and medication delivery efficiency.
Main Methods:
- A randomized crossover study involving 20 children (10-25 months) receiving budesonide (200 mcg) via three spacers (Nebuhaler, Aerochamber, Babyspacer) with facemasks.
- Budesonide dose deposited on a filter was measured to determine delivery efficiency.
- Children's minute ventilation was recorded during a 30-second inhalation period.
Main Results:
- The Aerochamber (140 ml) delivered significantly less budesonide (39.4 mcg) compared to the Nebuhaler (53.5 mcg) and Babyspacer (55.5 mcg).
- All spacers were effectively emptied within 30 seconds by the children's minute ventilation (mean 5.0 L/min).
- Spacer volume did not appear to be the primary determinant of budesonide delivery in this age group.
Conclusions:
- Spacer volume is less critical for budesonide delivery in infants aged 10-25 months, provided volumes under 750 ml are used.
- Effective medication delivery is achievable with various spacer sizes when used with facemasks and appropriate breathing patterns.
- Further research may explore other factors influencing inhaled corticosteroid efficacy in infants.
Abstract:
The budesonide dose delivered to the patient from three different spacer devices (Nebuhaler = 750 ml, Aerochamber = 140 ml, and Babyspacer = 260 ml) was assessed by measuring the budesonide dose deposited on a filter inserted between the spacer outlet and the mouth of the patient. Twenty children aged 10-25 months were given a single dose of 200 micrograms budesonide from each spacer device in a randomised crossover study. All spacers had a facemask attached and a one way valve system. The children breathed through the inhalation system for 30 seconds. Furthermore, the minute ventilation of the children through a tightly fitting facemask was measured. The filter dose of budesonide was significantly lower after Aerochamber treatment (39.4 micrograms, range 19-67 micrograms) than after Nebuhaler (53.5 micrograms, range 34-88 micrograms) and Babyspacer (55.5 micrograms, range 39-76 micrograms) treatment. The minute ventilation of the children varied from 1.4 l/min to 7.0 l/min (mean 5.0 l/min). This was sufficient to empty all spacers within the 30 seconds of inhalation. It is concluded that spacer volume does not seem to be so important for children aged 10-25 months as long as spacers with a volume lower than 750 ml are used.