Two new publications build on previous evidence that not all devices are equally effective in delivering asthma control.
A recent article in Pulmonary Pharmacology and Physiology1 provides in vitro evidence that the AeroChamber Plus* Flow-Vu* valved holding chamber (or spacer) delivers aerosolized drug more effectively than other chambers, a view further supported in a new literature review published in Therapeutic Advances in Respiratory Disease.2
The use of spacers with Metered Dose Inhalers (MDIs) has become firmly established in the management of asthma and COPD, with guidelines such as the Global Initiative for Asthma (GINA)3 recommending their use to reduce oropharyngeal deposition of drug, and counter the common problem of poor inhaler technique. What is not established, however, is whether there are any meaningful differences between the devices. While GINA guidelines do indicate that not all are the same – a view echoed by the European Medicines Agency (EMA) recommendations,4 which state that data for MDIs should be generated with a ‘specific named spacer’ – this view is not expressed in all guidelines. Two recent publications set out to address the impact of spacer design on drug delivery performance and look at potential implications for clinical use.
Four similarly sized chambers were compared ‘out of the box’ in terms of statistical equivalence with the gold standard AeroChamber Plus* chamber with respect to retention of drug particles within the device and the aerodynamic particle size distribution of the drug particles delivered. Only the AeroChamber Plus* Flow-Vu* chamber demonstrated an equivalent profile of dose retention and delivery versus the reference chamber. The Compact Space Chamber Plus™ (Medical Developments), the OptiChamber Diamond™ (Philips Respironics, Inc), and InspiraChamber™ (Lupin Pharmaceuticals, Inc) devices all retained approximately twice as much drug, delivering around half the dose and showing non-equivalent performance compared with the AeroChamber Plus* Flow-Vu* chamber and reference chamber (pretreated AeroChamber Plus* chamber).
Lead author, Dr Sanjeeva Dissanayake, has recently published a literature review in Therapeutic Advances in Respiratory Disease, which provides further support for these findings. In considering the important attributes of such delivery devices, the review notes a shift in emphasis from chamber size and shape to other aspects, such as consistency of drug delivery, static charge reduction, valve performance, and factors optimizing facemask effectiveness (such as flexibility and seal). Despite the general lack of published clinical studies that confirm the therapeutic benefits of such differences, the AeroChamber* ‘family’ of chambers has amassed an impressive body of clinical evidence. Most recently, a real-world database study5 has demonstrated improved clinical benefits and reduced resource utilization use with the AeroChamber Plus* Flow-Vu* chamber vs other chambers in patients with asthma. A study specifically looking at the Flow-Vu* inhalation indicator has also shown benefits for carer confidence in dose delivery, and improved care-giver preference and quality of life.6
Dr Dissanayake commented, ‘The in vitro equivalence study results and the literature review findings provide strong support for the EMA guideline recommendations that data for MDIs should be generated with specific spacer devices, and further reinforce the view that superficially similar chambers should not automatically be considered to be interchangeable - even if superficially similar'.
See the study Are valved holding chambers (VHCs) interchangeable? An in vitro evaluation of VHC equivalence
See the study A review of the in vitro and in vivo valved holding chamber (VHC) literature with a focus on the AeroChamber Plus* Flow-Vu* Anti-Static VHC
For clinical inquiries, please contact:
Jason Suggett PhD, BPharm, MBA, MRPharmS
Group Director of Global Science and Technology
1. Dissanayake S, Nagel M, Falaschetti E, Suggett J. Are valved holding chambers (VHCs) interchangeable? An in vitro evaluation of VHC equivalence. Pulmonary Pharmacology & Therapeutics. 2018; 48:179-184 https://doi.org/10.1016/j.pupt.2017.10.005
2. Dissanayake S, Suggett J. A review of the in-vitro and in-vivo valved holding chamber (VHC) literature with a focus on the AeroChamber Plus Flow-Vu anti-static VHC. Therapeutic Advances in Respiratory Disease. 2018; 12. https://doi.org/10.1177/1753465817751346
3. Global Initiative for Asthma: Global strategy for asthma management and prevention, 2017 Available from: www.ginaasthma.org. 2017.
4. Dissanayake S. Application of the EU Guidelines for Pharmacokinetic Studies of Locally Acting Orally Inhaled Drug Products. Respiratory Drug Delivery 2010. Vol 12010:293-304.
5. Burudpakdee, C., Kushnarev, V., Coppolo, D. et al. Pulmonary Therapy. 2017; 3(2):283-96. https://doi.org/10.1007/s41030-017-0047-1
6. Ammari WG, Toor S, Chetcuti P, Stephenson J, Chrystyn H. Evaluation of asthma control, parents' quality of life and preference between AeroChamber Plus and AeroChamber Plus Flow-Vu spacers in young children with asthma. The Journal of Asthma: Oofficial journal of the Association for the Care of Asthma. 2015;52(3):301-307.
7. AeroChamber brand of holding chambers. Study Summary (September 2017). Available from: https://www.trudellmed.com/aerochamber-study-summary