Optimizing the Delivery of Inhaled Medication for Respiratory Patients: The Role of Valved Holding Chambers

Abstract

Valved holding chambers (VHCs) have been used with pressurized metered-dose inhalers since the early 1980s. They have been shown to increase fine particle delivery to the lungs, decrease oropharyngeal deposition, and reduce side effects such as throat irritation, dysphonia, and oral candidiasis that are common with use of pressurized metered-dose inhalers (pMDIs) alone. VHCs act as aerosol reservoirs, allowing the user to actuate the pMDI device and then inhale the medication in a two-step process that helps users overcome challenges in coordinating pMDI actuation with inhalation. The design of VHC devices can have an impact on performance. Features such as antistatic properties, effective face-to-facemask seal feedback whistles indicating correct inhalation speed, and inhalation indicators all help improve function and performance, and have been demonstrated to improve asthma control, reduce the rate of exacerbations, and improve quality of life. Not all VHCs are the same, and they are not interchangeable. Each pairing of a pMDI device plus VHC should be considered as a unique delivery system.

Homemade valved holding chambers for children with airway hyperresponsiveness: A randomized crossover trial

“…Aerochamber® was used as a reference of commercial VHCs in 4 out of the 6 trials. In this current study, we also used Aerochamber® as a reference not only because it is available in our country but it also has considerably scientific data especially in young children 6,25,26 . The findings of our study are consistent with those previously reported.…”

Is Inhaler Technique Associated with Quality of Life in Patients with Chronic Obstructive Pulmonary Disease?

“…Generally, pressurized metered-dose inhalers (pMDIs) are the most frequently used devises worldwide due to their acceptable cost, effectiveness, and simple technique. 8 Although inhaled medications are considered the optimal route and gold standard for the treatment of COPD, their delivery to the site of action can be challenging. In fact, most patients are not able to use the devices correctly without training and some cannot use them properly despite education.…”

“…In fact, most patients are not able to use the devices correctly without training and some cannot use them properly despite education. 7 , 8 It has been proposed that patients’ technique of using devices can lead to a significant difference in clinical response even between pMDIs and dry powder inhalers (DPIs) despite their similar efficacy in correct use. 9 In a systematic review of the studies published between 1975 and 2014, a high prevalence of inappropriate device use among patients with pulmonary disorders was noted.…”

Comment on “Optimizing the Delivery of Inhaled Medication for Respiratory Patients: The Role of Valved Holding Chambers”

“…McIvor et al [1] recently suggested that regulatory authorities (e.g., US Food and Drug Administration (FDA), Health Canada, and Japan's Pharmaceuticals and Medical Devices Agency) should harmonize and follow the European Medicines Agency (EMA) recommendation that valved holding chambers (VHCs) are not interchangeable.…”

“…In our opinion, using only laboratory criteria to determine superiority of any MDI + VHC combination over another fails to take into account important “real-world” device and patient-related clinical issues. These are determined by pMDI and VHC/mask design features that individually or in combination will surely have an effect that is equal to or greater than the recent laboratory-demonstrated differences in various MDI + VHC combinations [2] that, as a result, have led to totally unwarranted clinical conclusions [1].…”