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A Comparative Study of Two Different Metered-Dose Inhaler-Valved Holding Chambers in the Administration of Salbutamol FREE TO VIEW

Federica Di Berardino, MD; Stella Forti, BMath; Gioia Piatti, MD, PhD; Valter Fasano, MD, PhD
Author and Funding Information

From the Audiology Unit (Dr Berardino and Ms Forti), Department of Specialistic Surgical Sciences and the Department of Thoracic and Cardiovascular (Drs Piatti and Fasano), Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, University of Milan.

Correspondence to: Federica Di Berardino, MD, Audiology Unit, IRCCS, via Pace 9, Milan, Italy; e-mail: federica.diberardino@unimi.it


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;137(2):502-503. doi:10.1378/chest.09-1995
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To the Editor:

Rapid-acting, inhaled β-2 agonists are frequently delivered from a pressurized, metered-dose inhaler (MDI) used with a valved holding chamber (VHC). Several studies have shown that VHCs enhance the efficacy of short-acting β-2 agonists in patients who have poor MDI technique and in children. However, different VHCs are available for inhaled therapy without information in the summaries of product characteristics and patient information leaflets on studies of efficacy and compatibility between drugs and VHCs. To provide that, we suggest a method already proposed to standardize first-step delivery of aerosolized drugs.1

We compared the performance of a new VHC (L’Espace; Markos Mefar; Bovezzo Bs, Italy) with the AeroChamber (Trudel Medical International; USA) to verify whether they were equally suitable for use in the delivery of a specific drug. Their efficacy was expressed as: (1) the amount of drug within the respirable range (ADRR) according to the formula described by Malone,2 that is, the drug output (measured immediately after treatment in duplicate using high-performance liquid chromatography) multiplied by the percentage of output within the respirable range, determined using a laser diffraction analyzer3; and (2) as the improvement of spirometric parameters. Forty patients with asthma were examined during severe asthma attacks (FEV1〈60% of the predicted value) and underwent bronchodynamic tests: 20 received salbutamol using L’Espace, and 20 using AeroChamber.

ADRR was calculated as 86.0 ± 1.1 vs 84.0 ± 0.8 μg, and the percentages of change from baseline of the spirometric values were FEV1 15.4 ± 12 vs 16.1 ± 13; peak expiratory flow, 8.9 ± 9 vs 12.8 ± 13; forced expiratory flow at 25% to 75% of the forced vital capacity, 23.9 ± 22 vs 14.3 ± 20 (L’Espace vs AeroChamber) (Table 1). Both of the VHCs tested were suitable for use in the delivery of salbutamol.

Table Graphic Jump Location
Table 1 —Baseline Spirometric Parameters and Related Improvements After Therapy

Baseline spirometric parameters and related improvements after therapy are expressed as percentages of predicted values. FEF75 = forced expiratory flow at 25% to 75% of the forced vital capacity; PEF = peak expiratory flow; VHCs = valved holding chambers.

This method has also been employed to compare traditional and abbreviated salbutamol aerosol therapy using a new VHC mouth mask.4 In that study, abbreviated aerosol therapy using the new VHC mouth mask delivered 176 μg of salbutamol, giving an FEV1 increase of 34%. In line with that result, we obtained half the increase in FEV1 using half the dose. Therefore, because VHC characteristics may interfere with MDI drug delivery, it is recommended that compatibility be verified and the specific therapeutic dose be determined. For this reason, manufacturers should report ADRR and compatibility between drugs and VHCs.

Di Berardino L, Varricchio A, Teti L.Dalby RN, Byron PR, Peart J, Suman JD, Farr SJ. Two basic parameters to standardize the delivery of aerosolized drugs. Respiratory Drug Delivery. 2004;Vol 2 Richmond, VA Virginia Commonwealth University:545-548
 
Malone RA, Hollie MC, Glynn-Barnhart A, Nelson HS. Optimal duration of nebulized albuterol therapy. Chest. 1993;1044:1114-1118. [CrossRef] [PubMed]
 
Loffert DT, Ikle D, Nelson HS. A comparison of commercial jet nebulizers. Chest. 1994;1066:1788-1792. [CrossRef] [PubMed]
 
Galli E, Gianni S, Di Fazio A, Brunetti E, Di Berardino L. Comparison of traditional and abbreviated salbutamol aerosol therapy using a new spacer mouth mask. Allergy Asthma Proc. 2007;286:688-690. [CrossRef] [PubMed]
 

Figures

Tables

Table Graphic Jump Location
Table 1 —Baseline Spirometric Parameters and Related Improvements After Therapy

Baseline spirometric parameters and related improvements after therapy are expressed as percentages of predicted values. FEF75 = forced expiratory flow at 25% to 75% of the forced vital capacity; PEF = peak expiratory flow; VHCs = valved holding chambers.

References

Di Berardino L, Varricchio A, Teti L.Dalby RN, Byron PR, Peart J, Suman JD, Farr SJ. Two basic parameters to standardize the delivery of aerosolized drugs. Respiratory Drug Delivery. 2004;Vol 2 Richmond, VA Virginia Commonwealth University:545-548
 
Malone RA, Hollie MC, Glynn-Barnhart A, Nelson HS. Optimal duration of nebulized albuterol therapy. Chest. 1993;1044:1114-1118. [CrossRef] [PubMed]
 
Loffert DT, Ikle D, Nelson HS. A comparison of commercial jet nebulizers. Chest. 1994;1066:1788-1792. [CrossRef] [PubMed]
 
Galli E, Gianni S, Di Fazio A, Brunetti E, Di Berardino L. Comparison of traditional and abbreviated salbutamol aerosol therapy using a new spacer mouth mask. Allergy Asthma Proc. 2007;286:688-690. [CrossRef] [PubMed]
 
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