Ojanperä Laura, Lehtimäki Lauri, Huhtala Heini, Csonka Péter
Centre for Child Health Research, Tampere University, Arvo Ylpön katu 34, Tampere, 33520, Finland.
Tampere University Hospital, Kalevantie 4, Tampere, 33014, Finland.
Pediatr Pulmonol. 2025 Jan;60(1):e27300. doi: 10.1002/ppul.27300. Epub 2024 Sep 30.
There is a scarcity of high-quality research on the efficient delivery of inhaled corticosteroids using valved holding chambers (VHCs) in children.
The delivered dose (DD) of fluticasone from a metered dose inhaler (pMDI) was tested using four VHCs: AeroChamber plus Flow-Vu (AC), Babyhaler (BH), EasyChamber (EC), and Optichamber Diamond (OD). The in vitro setup included an anatomical child throat model, Next Generation Impactor, and a breathing simulator to generate tidal breathing of a four and a 6-year-old child, and adult type single inhalation.
OD showed the lowest proportion of fluticasone trapped in the throat with all breathing patterns. AC showed similar fine particle dose (FPD) in the respirable range (1-5 µm) irrespective of the breathing pattern. For BH, the median FPD 1-5 µm was highest during adult breathing. OD and EC showed higher overall DD and higher doses in the 1-5 µm range with paediatric breathing profiles compared to adult inhalation. The median DD and FPD 1-5 µm were significantly lower with BH compared to any other VHCs during tidal breathing. Compared to EC, the FPD of the other VHCs were skewed towards <2 µm particles.
Fluticasone delivery is markedly affected by breathing pattern and VHC model. The observed differences in throat deposition and FPD delivered may have significant clinical implications for side effects and controlling airway inflammation. All VHCs intended for paediatric use should undergo testing using internationally recognised standardised methods incorporating clinically relevant paediatric breathing patterns.
关于儿童使用带储雾罐（VHCs）高效递送吸入性糖皮质激素的高质量研究较少。
使用四种储雾罐测试定量吸入器（pMDI）中氟替卡松的递送剂量（DD）：AeroChamber plus Flow-Vu（AC）、Babyhaler（BH）、EasyChamber（EC）和Optichamber Diamond（OD）。体外设置包括儿童解剖学咽喉模型、下一代撞击器和呼吸模拟器，以模拟4岁和6岁儿童的潮式呼吸以及成人单次吸入。
在所有呼吸模式下，OD显示被困在咽喉中的氟替卡松比例最低。无论呼吸模式如何，AC在可吸入范围内（1-5μm）显示出相似的细颗粒剂量（FPD）。对于BH，在成人呼吸时，1-5μm的FPD中位数最高。与成人吸入相比，OD和EC在儿童呼吸模式下显示出更高的总体DD以及1-5μm范围内更高的剂量。在潮式呼吸期间，与任何其他储雾罐相比，BH的DD和1-5μm的FPD中位数显著更低。与EC相比，其他储雾罐的FPD偏向<2μm的颗粒。
氟替卡松的递送受呼吸模式和储雾罐型号的显著影响。观察到的咽喉沉积和递送的FPD差异可能对副作用和控制气道炎症具有重要的临床意义。所有用于儿童的储雾罐都应采用纳入临床相关儿童呼吸模式的国际认可标准化方法进行测试。
