This study was presented at the Drug Delivery to the Lungs Conference, 2022.

Summary:

Presented at DDL 2017 in Edinburgh

• Valved holding chambers are widely prescribed to assist patients receiving inhaled medications by avoiding losses caused by imperfect coordination of inhalation and actuation and also to reduce oropharyngeal deposition.
• Regardless of whether using a solution based formulation (like Qvar) or a suspension formulation (Flovent), the use of a valved holding chamber reduced the amount of medication deposited in the mouth (oropharynx) and increased the potential for lung delivery
• This study can be used to help demonstrate the value of using a valved holding chamber for both solution and suspension formulated metered dose inhalers and for all patient populations, including adults

This study was presented at the Drug Delivery to the Lungs, 2022.

The FRI deposition profiles highlighted significant differences between the VHCs on test, with intrathoracic delivery for the AeroChamber Plus* Flow-Vu* VHC system being almost double that of the other two VHC systems and being similar to the MDI alone with perfect coordination

• The FRI deposition profiles highlight that the MDI/AeroChamber Plus* Flow-Vu* VHC delivered a significantly greater percentage of drug to the lung region than either of the two DPIs, irrespective of flow rate.
• This was reflected in much higher modelled oropharyngeal deposition for the two DPIs.
• The influence of inhalation flow profile was significant for one of the DPIs.

Conclusions:

• The FRI deposition profiles highlight that the MDI/ AeroChamber Plus* Flow Vu* VHC system delivered an appreciably greater percentage of drug to the lung region than either of the two DPIs.
• The influence of inhalation flow profile was less with the MDI/VHC system and differed between the two DPIs.

• The FRI deposition profiles highlight that the MDI/ AeroChamber Plus* Flow Vu* VHC system delivered an appreciably greater percentage of drug to the lung region than either of the two DPIs.
• The influence of inhalation flow profile was less with the MDI/VHC system and differed between the two DPIs.

Conclusions:

• The widely differing inspiratory flow profiles from Turbuhaler† DPI contributed to greater variability in delivered dose to the carina. 
• MDI delivery via the AeroChamber Plus* Flow-Vu* VHC resulted in significantly increased mass to the carinal region irrespective of inhalation maneuver as well as reduced oropharyngeal deposited mass which in vivo is likely to result in reduced throat irritation or thrush in the mouth and throat.

Conclusions:

• The most efficient and effective delivery method remains that recommended in the device IFU (one actuation inhaled at a time, as well inhalation as soon as possible after actuation)
• However, this laboratory-based study has indicated that a modified common-canister protocol with an anti-static VHC as the aerosol transfer vehicle has the potential to be a viable ‘off-label’ proposition in hospital situations where there is an urgent need to conserve pMDI medication as well as avoid cross-contamination from pathogenic viruses or bacteria

PRESENTED AT VIRTUAL ATS 2020

• Evaluations of inhaler use have demonstrated that mishandling of MDIs is commonplace.
• One of the most common errors is the failure to coordinate inhalation with actuation of the inhaler
• One of the reasons why VHCs are often prescribed, is to reduce the severity of this error
• This Functional Respiratory Imaging (FRI) based study assessed the likely severity of a short inhalation delay (from actuation) with an MDI alone and how it contrasted to the use with a VHC

RDD 2020 - E-Poster Presentation

COPD is a chronic and progressive disease that requires regular self-administration of inhaled medications. However, as the disease progresses, reduced respiratory muscle strength may prevent patients from generating sufficient inspiratory effort to effectively use dry-powder inhalers (DPIs) [1, 2]. In contrast, patients can inhale slowly or breathe tidally from a pMDI with VHC without the need to coordinate with inhaler actuation [3].

This lab study compared a number of VHCs for patient usability and safety factors. 

Conclusions:

From a UK perspective, BUD/F delivered via an MDI + VHC offers an economic benefit for the treatment of patients with mild asthma. Further analysis is required to determine if there would be any quality-adjusted life-year (QALY) effects based on the chosen intervention.

Depending on the pMDI/spacer system chosen the delivery of medication can vary significantly and as a result will have implications on the potential carbon footprint.

In this case, the use of the AeroChamber Plus* Flow-Vu* VHC could potentially reduce the carbon footprint by three fold compared to the alternative spacers.

By maximizing the amount of each puff reaching the lungs the patient is likely to be able to get relief sooner and reduce the amount of puffs needed.

Presented at the British Thoracic Society December 2018.

Having a child with asthma can be stressful for parents, especially for financially strapped ones struggling to pay for an arsenal of puffers and pills for their child’s treatment. Because of this, those healthcare professionals who recommend spacer chambers may suggest one of many lower-cost versions that are available on the market today. But focusing only on cost may be putting a child’s health at risk.