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.
Highlights
Inhaled therapy is the gold standard for treatment of asthma [1] and chronic obstructive pulmonary disease (COPD) [2] in patients treated with pressurized metered-dose inhalers. e first pMDI was introduced in 1956 by Riker Laboratories Inc. and constituted a significant advancement in the delivery of aerosol medication [3]. pMDIs are the most widely used devices for the delivery of aerosol medication because of their low cost, effectiveness, and relative simplicity of use [4]
Some people will revert back to bad technique, and some will not benefit from training [17]. e most common errors associated with pMDIs are the lack of coordination between actuation and inhalation; halting inhalation when the cool spray hits the back of the throat; not holding the breath long enough (>5 seconds) after inhalation; no exhalation prior to actuation; and not shaking the suspension prior to use [13, 18]
TM study which showed that both the AeroChamber and TM Volumatic devices used in the study reduced oropharyngeal deposition of HFA-134a-beclomethasone dipropionate (BDP) and CFC-BDP. ey found that oropharyngeal deposition of HFA-BDP was reduced from approximately 28% to 4% with the AeroChamber
Summary
Inhaled therapy is the gold standard for treatment of asthma [1] and chronic obstructive pulmonary disease (COPD) [2] in patients treated with pressurized metered-dose inhalers (pMDIs). e first pMDI was introduced in 1956 by Riker Laboratories Inc. and constituted a significant advancement in the delivery of aerosol medication [3]. pMDIs are the most widely used devices for the delivery of aerosol medication because of their low cost, effectiveness, and relative simplicity of use [4]. Giraud and Roche [18] showed that 71% of adult asthmatic patients are unable to use their inhaler devices effectively, resulting in decreased control of asthma symptoms All of these lead to increased health-care expenditure [20]. Spacer devices and VHCs were initially designed to increase delivery of aerosol medications to the lungs while reducing the oropharyngeal deposition [3]. Roller et al [32] found that for children (to ages 17 years) using VHCs with pMDI devices, slow inhalation and breath hold (5–10 seconds) may be more effective than tidal breaths for lung deposition of extra-fine aerosols for users who are capable of this type of breathing. Spacers made of antistatic materials or metals such as steel or aluminum are less subject to this problem and with the incorporation of an effective antistatic material, remove the need for washing with detergent prior to first use [31]
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