Comparative <i>In Vitro</i> Performance of Three Small-Volume Valved Holding Chambers with Beclomethasone/Formoterol Pressurized Metered Dose Inhaler

Gonçalves, Talita Mota; Alhanout, Kamel; Nicolay, Alain; Dubus, Jean‐Christophe; Santana, Davi Pereira de; Andrieu, Véronique

doi:10.1089/jamp.2011.0952

Cited by 14 publications

(11 citation statements)

References 13 publications

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“…30 Similar results were reported in other studies of salbutamol and beclomethasone/formoterol pMDIs. 51 , 52 Importantly, where a 2 s delay in sampling was imposed for the AC+FV aVHC, simulating use by a more representative semi-coordinated patient, the FPD remained similar to that via a pMDI coordinated perfectly (FPD ratio approximately 85–120%). 30…”

Section: Resultsmentioning

confidence: 99%

A review of the in vitro and in vivo valved holding chamber (VHC) literature with a focus on the AeroChamber Plus Flow-Vu Anti-static VHC

Dissanayake¹,

Suggett

2018

Ther Adv Respir Dis

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Valved holding chambers (VHCs) reduce the need for inhalation-actuation coordination with pressurized metered dose inhalers (pMDIs), reduce oropharyngeal drug deposition and may improve lung deposition and clinical outcomes compared to pMDIs used alone. While VHCs are thus widely advocated for use in vulnerable patient groups within clinical and regulatory guidelines, there is less consensus as to whether the performance differences between different VHCs have clinical implications. This review evaluates the VHC literature, in particular the data pertaining to large- versus small-volume chambers, aerosol performance with a VHC adjunct versus a pMDI alone, charge dissipative/conducting versus non-conducting VHCs, and facemasks, to ascertain whether potentially meaningful differences between VHCs exist. Inconsistencies in the literature are examined and explained, and relationships between in vitro and in vivo data are discussed. A particular focus of this review is the AeroChamber Plus® Flow-Vu® Anti-static VHC, the most recent iteration of the AeroChamber VHC family.

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Section: Resultsmentioning

confidence: 99%

A review of the in vitro and in vivo valved holding chamber (VHC) literature with a focus on the AeroChamber Plus Flow-Vu Anti-static VHC

Dissanayake¹,

Suggett

2018

Ther Adv Respir Dis

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“…23 Several previous studies have reported similar results, namely that the accessory device significantly increased the relative lung bioavailability compared to the pMDI alone (P Ͻ .01). 10,22,24,25 This may be because inhalation from an accessory device decreases the velocity of the aerosol particles and allows some evaporation of the propellant, thereby decreasing the particle size and the quantity of salbutamol deposited in the patient's mouth and throat (represented by the induction port of the Andersen MKII cascade impactor in this study). 22 When using the pMDI without an accessory device, the majority of the emitted dose was deposited in the induction port, but when using the accessory devices, the majority of the emitted dose was deposited in the accessory device.…”

Section: Discussionmentioning

confidence: 96%

“…9 Most traditional accessory devices on the market are made from lightweight plastic for greater durability and enhanced device portability. 10,11 Polypropylene and polycarbonate are the most commonly used materials for making plastic spacers or valved holding chambers; however, their non-conducting nature encourages electrostatic charges within the device. [12][13][14] Because drugs released from pMDIs also are electrically charged, electrostatic reactions inevitably occur between the charged walls of the accessory device and the emitted drug.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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BACKGROUND: 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. METHODS: 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. RESULTS: The mean ؎ SD total emitted dose from the pMDI alone, 155.2 ؎ 20.5 g, 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 g and 131.5 ؎ 11.8 g, respectively). The mean ؎ SD total emitted doses with the AeroChamber Plus valved holding chamber (61.9 ؎ 8.9 g) and the DispozABLE paper spacer (76.4 ؎ 8.6 g) 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 g) and the DispozABLE paper spacer (39.7 ؎ 5.6 g) 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. CONCLUSIONS: 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.

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“…There are few substantial studies that estimate the magnitude and clinical impact of these effects in real life [ 58 ]: most of these address the effects of spacers/VHCs on the bronchodilatation produced by short-acting β-agonists (and do suggest a measurable effect, even in patients with good pMDI technique) [ 50 , 59 ], although some address the effects of inhaled corticosteroids. Devices made of antistatic materials further increase the delivery of the respirable particle fraction [ 46 , 51 , 52 , 60 ], although again the effects are sometimes marginal [ 55 , 56 , 61 ], and the clinical consequences of this for real-life disease control are unclear.…”

Section: Assessing the Potential Impact Of Spacers/vhcs On Drug Delivmentioning

confidence: 99%

Spacer devices for inhaled therapy: why use them, and how?

et al. 2018

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We present an extensive review of the literature to date pertaining to the rationale for using a spacer/valved holding chamber (VHC) to deliver inhaled therapy from a pressurised, metered-dose inhaler, a discussion of how the properties of individual devices may vary according to their physical characteristics and materials of manufacture, the potential risks and benefits of ancillaries such as valves, and the evidence that they contribute tangibly to the delivery of therapy.We also reiterate practical recommendations for the correct usage and maintenance of spacers/VHCs, which we trust offer practical help and advice to patients and healthcare professionals alike.

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Comparative In Vitro Performance of Three Small-Volume Valved Holding Chambers with Beclomethasone/Formoterol Pressurized Metered Dose Inhaler

Abstract: The Vortex and the ACP VHCs present interesting advantages over the AS VHC to be used with Innovair pMDI. However, these results are based on an in vitro evaluation and need to be validated in an in vivo study in order to clinically assess the performance of these VHCs.

Cited by 14 publications

References 13 publications

A review of the in vitro and in vivo valved holding chamber (VHC) literature with a focus on the AeroChamber Plus Flow-Vu Anti-static VHC

A review of the in vitro and in vivo valved holding chamber (VHC) literature with a focus on the AeroChamber Plus Flow-Vu Anti-static VHC

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

Spacer devices for inhaled therapy: why use them, and how?

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