Effect of a volumatic spacer and mouth rinsing on systemic absorption of inhaled corticosteroids from a metered dose inhaler and dry powder inhaler.

Selroos, Olof; Halme, Maija

doi:10.1136/thx.46.12.891

Cited by 129 publications

(37 citation statements)

References 9 publications

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“…Our results indicate that powder depositing in the mouth is more accessible for elimination by mouth-washing than powder in the pharynx by gargling. A recent study suggested that mouth-washing is indeed effective in reducing systemic side-effects [30], and the present results supported this, though mouth-washing and gargling removed only a mean of approximately 10% of the total body dose. Large amounts of activity were detected in the stomach immediately after inhalation from the Turbuhaler®, and much of the dose depositing in the upper airway is presumably swallowed soon after deposition and, is, hence, inaccessible to mouth-washing and gargling.…”

Section: Resultssupporting

confidence: 87%

Lung deposition from the Turbuhaler in children with cystic fibrosis

Devadason¹,

Everard²,

MacEarlan³

et al. 1997

Eur Respir J

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Drug delivery to patients using dry powder inhalers, such as the Turbuhaler®, is believed to be influenced by the inspiratory flow used. Clinical studies have indicated that this delivery system can be used effectively by children. However, it is not known how the total and weight-corrected dose delivered to the airways varies with age. A deposition study using technetium-99m ( 99m Tc)-labelled budesonide was performed in order to determine the effect of age on delivery.Twenty one children with cystic fibrosis, aged 4-16 yrs, were recruited. They were clinically stable with normal lung function. Initially, a gamma camera scan was taken in front of a flood source containing 37 MBq of 99m Tc. Subsequently, subjects inhaled through a low resistance inspiratory filter connected to a commercially available Turbuhaler®. Immediately afterwards they inhaled from a noncommercial Turbuhaler® containing budesonide labelled with 99m Tc, and then underwent anterior and posterior gamma camera scans. Both Turbuhaler® inhalers were attached to a portable spirometer and the peak inspiratory flow through the Turbuhaler® was recorded for each inhalation. The total body dose was calculated from the dose deposited on the inspiratory filter connected to the commercial Turbuhaler®. Analysis of the gamma camera images provided information on the proportion of the radiolabel delivered to the lungs compared to that deposited in the upper airway and stomach.As expected, a highly significant positive correlation was noted between the peak inspiratory flow generated by the patient through the Turbuhaler® and the dose delivered to the lung. Similarly, there was a highly significant positive correlation between age and "total lung dose". However, when total lung dose was corrected for body weight, there was a nonsignificant negative correlation with age. This study suggests that the "weight-corrected lung dose" achieved when children aged >6 yrs use the Turbuhaler®, is largely independent of age. It would appear that the flow-dependent properties of this device are such that the reduced peak inspiratory flow generated by younger children results in a lower dose to the lungs, but that this is off-set by their lower body weight. This is unlikely to be a property of other devices with different flow/drug delivery characteristics. Eur Respir J 1997; 10: 2023-2028 The convenience and ease of use of Turbuhaler®, a multidose dry powder inhaler (DPI), has resulted in its widespread use for the treatment of children with respiratory disease. Scintigraphic and pharmacokinetic deposition studies have indicated that this device is capable of delivering a mean of 20-30% of the nominal dose to the lungs of adults [1,2]. Although it is difficult to compare results from studies utilizing different methods [3], these results suggest that the device delivers a greater proportion of the nominal dose to the lungs of adult patients than do other DPIs [4,5], metereddose inhalers (MDIs) [4,6,7], and jet nebulizers [8,9], and these results are similar to o...

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Section: Resultssupporting

confidence: 87%

Lung deposition from the Turbuhaler in children with cystic fibrosis

Devadason¹,

Everard²,

MacEarlan³

et al. 1997

Eur Respir J

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“…Proper inhalation techniques and use of spacer devices, as well as rinsing the mouth after ICS inhalation, are effective [24][25][26] in lowering oropharyngeal ICS deposition, and thereby may reduce the occurrence of oral candidiasis [4]. Unfortunately, patient education about inhaler devices and inhalation techniques is not always given and when given, instruction is often rushed, of poor quality or not reinforced [27,28].…”

Section: Discussionmentioning

confidence: 99%

Inhaled Corticosteroids and the Occurrence of Oral Candidiasis: A Prescription Sequence Symmetry Analysis

2013

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Objectives The primary aim of the study was to gain insight into the relative risk of clinically relevant oral candidiasis following inhaled corticosteroid (ICS) initiation over time. A secondary aim was to analyse the influence of patient characteristics and co-medication on the occurrence of this adverse effect. Methods Drug prescription data from 1994 to 2011 were retrieved from the IADB.nl database. To study the influence of ICS use on occurrence of oral candidiasis, a prescription symmetry analysis was used, including patients using medication for oral candidiasis up to 1 year before or after ICS initiation. The relative risk was calculated by dividing the number of patients receiving medication for oral candidiasis after ICS initiation by the number of patients receiving the same medication before ICS initiation. Sub-analyses were conducted to compare the relative risks at several time points after ICS initiation and to account for therapy persistence by only including chronic users of ICS. A multivariate logistic regression model was used to identify predictive factors. Results A total of 52,279 incident users of ICS therapy were identified, of which 1,081 received medication for oral candidiasis up to 1 year before or after ICS initiation. A total of 701 patients received medication for oral candidiasis after ICS initiation, while 361 received these medications in the reversed sequence, resulting in a sequence ratio (SR) of 1.94 (95 % CI 1.71-2.21). In the first 3 months after ICS initiation, the SR was 2.72 (95 % CI 2.19-3.38) and then decreased to 1.47 (95 % CI 1.11-1.95) 9-12 months after ICS initiation. Predictive factors were higher daily dose of ICS and concomitant use of oral corticosteroids. Conclusions This study found a significant and clinically relevant increased number of patients receiving medication for oral candidiasis in the first year after therapy initiation with ICS. Relative risk is highest in the first 3 months, but remains increased up to at least 1 year after ICS initiation. This study stresses the need for patient education and inhalation instruction.

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“…However, for beclometasone dipropionate a high oropharyngeal deposition should be avoided because it increases systemic effects without an additional increase in clinical effect. [22][23][24] Therefore, beclometasone dipropionate should always be given by a spacer device or from a device such as the HFA-BDP Autohaler, which delivers ultrafine particles and therefore has less oropharyngeal deposition. 17 However, even for the Autohaler, use of a spacer improves the therapeutic ratio of beclometasone somewhat.…”

Section: Aerosol Deposition Patterns In Childrenmentioning

confidence: 99%