Inhalation therapy in asthma: Nebulizer or pressurized metered-dose inhaler with holding chamber? In vivo comparison of lung deposition in children☆,☆☆
Section snippets
Subjects
Seventeen children (13 boys) aged 2 to 9 years with asthma diagnosed according to the International Consensus Report on Diagnosis and Management of Asthma were recruited. Each patient had asthma in a stable state as judged by the absence of an exacerbation in the preceding 4 weeks and, where possible to measure, a forced expiratory volume (first second) >80% of predicted. Patients underwent a prestudy evaluation that included clinical examination and instruction in the optimal use of the
RESULTS
The mass median aerosol diameter from the nebulizer (n = 20) was 3.21 μm (SD 0.07). The drug particle size distributions from commercial and labeled salbutamol pMDIs compared with the distribution of the radioactivity assessed with the multistage liquid impinger showed a good correspondence. The mean (SD) amount of small particles (<3.1 μm) from stage 4, expressed as a percentage of the metered dose, was 39.8% (1.3), 41.4% (1.9), and 42.0% (3.5) for the drug from unlabeled commercial Ventolin
DISCUSSION
This study demonstrates that a nebulizer and a pMDI/holding chamber can be equally efficient in delivery of β2-agonists to the lungs of asthmatic children. However, a much higher absolute dose can be delivered from the nebulizer compared with the pMDI/ holding chamber, because the starting dose is much higher. A nebulizer also delivers a higher dose, when its longer inhalation time is taken into account and the total deposited dose is expressed as the dose deposited per minute of inhalation.
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Cited by (0)
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Reprint requests: Johannes Wildhaber, MD, University Children’s Hospital, Steinweisstrasse 75, CH-8032 Zurich, Switzerland.
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0022-3476/99/$8.00 + 0 9/21/96308