Deposition pattern of radiolabeled salbutamol inhaled from a metered-dose inhaler by means of a spacer with mask in young children with airway obstruction

Tal, Asher; Golan, Hava M.; Grauer, Nissan; Aviram, Micha; Albin, David S.; Quastel, Michael R.

doi:10.1016/s0022-3476(96)70357-8

Cited by 203 publications

(112 citation statements)

References 10 publications

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“…Irritation and agitation could greatly reduce the drug delivery to the infant's lungs and reduce treatment efficiency. 7,13,14 This could explain in part our findings of some clinical advantage of hood versus mask nebulization. Infant's comfort plays an important role in growing premies.…”

Section: Discussionmentioning

confidence: 91%

Hood versus mask nebulization in infants with evolving bronchopulmonary dysplasia in the neonatal intensive care unit

Kugelman

Amirav²,

Mor

et al. 2005

J Perinatol

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Objective: To compare infants' discomfort, nursing-time and caregiver preference, and assess the clinical efficiency (as a secondary outcome) of hood versus facemask nebulization in infants with evolving bronchopulmonary dysplasia (BPD) in the neonatal intensive care unit. Study Design:A prospective, open, randomized, controlled crossover clinical trial. In total, 10 infants with BPD who were on inhaled betaagonist bronchodilators and corticosteroids were randomly assigned to receive their nebulized treatments either by a facemask, or by a hood for 2-3 days, and then crossover to receive the same treatments with the other technique for another 2-3 days. Infants' discomfort, nursing-time, caregiver preference and clinical efficiency were compared.Results: At baseline there was no significant clinical difference between the groups. Nurse-time required for administering the hood nebulization (mean±s.e.m.: 1.9±0.1 min) was significantly shorter than the time for mask nebulization (12.0±0.6 min, P<0.0001). Infants' discomfort score was significantly lower (0.1±0.04) for hood versus mask nebulization (2.5±0.2, P<0.0001). Nurses and parents unequivocally preferred the hood treatment. During both mask and hood nebulization therapies (2-3 days) clinical efficiency was comparable. While both methods caused an immediate (20 min post) clinical improvement, the immediate respiratory assessment change score was significantly greater for the hood versus the mask nebulization (0.62±0.27 versus 0.13±0.14, P<0.05).Conclusions: Nebulization of aerosolized medications in infants with evolving BPD by hood was less time-consuming for caregivers and was much better tolerated by the infants while being at least as effective as the conventional facemask nebulization.

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Section: Discussionmentioning

confidence: 91%

Hood versus mask nebulization in infants with evolving bronchopulmonary dysplasia in the neonatal intensive care unit

Kugelman

Amirav²,

Mor

et al. 2005

J Perinatol

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“…There are few deposition studies involving the use of a spacer device, and the results of these studies are highly variable. TAL et al [12] evaluated the deposition of directly radiolabelled salbutamol in two adult volunteers after inhalation through an Aerochamber1, and found a mean lung deposition of 19%. However, their study refers to deposition in children rather than in adults, and the deposition values in that study are typically lower.…”

Section: Discussionmentioning

confidence: 99%

Washing plastic spacers in household detergent reduces electrostatic charge and greatly improves delivery

Pierart¹,

Wildhaber²,

Vrancken³

et al. 1999

Eur Respir J

144

109

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Ionic detergents reduce electrostatic charge on plastic spacers, thereby improving in vitro drug delivery. The aim of this study was to gain practical information on the use of detergents and to evaluate the relevance of this information on in vivo drug deposition. Measurement of electrostatic charge and salbutamol particle size distribution was carried out on detergent-coated and noncoated plastic spacers. The efficiency of four household detergents was compared, and the influence of dilution and the duration of the antistatic effect were studied. In addition, the level of radiolabelled salbutamol deposition in the lungs of eight healthy adults was compared after inhalation through a new versus a detergent-coated spacer. In vitro, all tested detergents reduced the electrostatic charge on the spacer surface. This resulted in a mean increase of 37.4% (range 33.5-41.2) in small particle (<6.8 microm) salbutamol output compared with water-rinsed/drip-dried spacers. Dilution had no influence on the results and the effect lasted for at least four weeks. In vivo, the mean lung deposition of radiolabelled salbutamol in healthy subjects was 45.6% (range 43.4-49.5) through a detergent-coated spacer compared to 11.5% (range 7.6-17.9) through a static spacer (p<0.001). In conclusion, household detergents offer a simple and practical solution to the problem of static on plastic spacers and significantly improve both in vitro and in vivo delivery of salbutamol.

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“…Similar conclusions were reached in a deposition study in infants, using metered-dose inhalers with valved holding chambers. 34 The in vitro data for the delivery system used in that study 10 did employ varying definitions of respirable fraction and patterns of breathing, based on size of the child, and did suggest that the expected pulmonary dose for the breathing pattern of a small child would be significantly less than that for an older child or adult.…”

Section: Discussionmentioning

confidence: 99%

Respiratory System Deposition with a Novel Aerosol Delivery System in Spontaneously Breathing Healthy Adults

Coates¹,

Leung²,

Chan

et al. 2013

Respir Care

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BACKGROUND: Intravenous magnesium sulfate (MgSO 4 ) in children and adults with refractory acute asthma is effective, but therapy may be limited by systemic hypotension that might be avoided with the aerosol route. Inhaled MgSO 4 has a relatively high dose (volume) requirement. This, plus the use of inefficient delivery systems, may explain the lack of efficacy of inhaled MgSO 4 in some studies. An in vitro study suggested that the AeroNeb Go with the Idehaler Pocket and a face mask would deliver 16 mg/min of MgSO 4 to the respiratory system in older children, and approximately a fifth for toddlers, but no in vivo data exist. METHODS: Saline mixed with a radiolabel was used as a proxy for the 100 mg/mL MgSO 4 solution. In 5 adult males the rate of deposition was measured using nuclear medicine techniques. The radiolabel deposition below the vocal cords was converted to the rate of deposition of MgSO 4 and compared to the results from an in vitro model using adult respiratory patterns. RESULTS: The mean ؎ SD rate of deposition was 12.6 ؎ 1.9 mg/min. The reasons for this lower deposition, compared to the in vitro estimate, was most likely the exhalation of anatomical dead space aerosol, which would have been captured on the inspiratory filter in vitro. CONCLUSIONS: These in vivo data confirm the deposition data predicted in the in vitro study, although caution should be used in extrapolating the results to children. This device appears suitable for the clinical trial of inhaled MgSO 4 in children and adults with refractory asthma.

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Deposition pattern of radiolabeled salbutamol inhaled from a metered-dose inhaler by means of a spacer with mask in young children with airway obstruction

Cited by 203 publications

References 10 publications

Hood versus mask nebulization in infants with evolving bronchopulmonary dysplasia in the neonatal intensive care unit

Hood versus mask nebulization in infants with evolving bronchopulmonary dysplasia in the neonatal intensive care unit

Washing plastic spacers in household detergent reduces electrostatic charge and greatly improves delivery

Respiratory System Deposition with a Novel Aerosol Delivery System in Spontaneously Breathing Healthy Adults

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