Chest
Volume 84, Issue 1, July 1983, Pages 36-41
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Clinical Investigations
Clinical Evaluation of a Simple Demand Inhalation MDI Aerosol Delivery Device

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Inhalation of medication is the preferred method for treating reversible airway obstruction; however, difficulties in the use of pressurized canisters frequently lead to suboptimal results. The Aerochamber (Monoghan Medical Corp) is a portable breath-actuated device that attaches to a mete red-dose inhaler (MDI) and is designed to overcome many of the problems of aerosol delivery encountered by some patients. The attachment of this breath-actuated device to an MDI reduced pharyngeal deposition of aerosol 14-fold, but delivery of aerosol to intrapulmonary airways in normal subjects and patients with bronchitis remained unchanged. In a group of nine patients with stable asthma, inhalation of a bronchodilator aerosol using the breath-actuated device (Aerochamber) achieved effective bronchodilation similar to an optimally administered MDI. Advantages of the breath-actuated device (Aerochamber) include (1) aerosol delivery of medication whether or not the discharge of aerosol is synchronized with inhalation, (2) effective therapeutic response compared with optimally administered MDI; (3) greatly reduced deposition of aerosol in the upper airways, which might be expected to reduce adverse effects of steriods; and (4) universal application to all bronchodilator and steroid MDIs.

Section snippets

Pulmonary Aerosol Deposition

Subjects. Seven nonsmoking adults with no history of respiratory disease served as the normal group (Table 1). For comparison, 14 adult ambulatory patients with varying degrees of airflow obstruction were selected from the Firestone Regional Chest and Allergy Unit of St. Joseph's Hospital (Table 1). Patients continued to receive their usual medication. Informed written consent was obtained from all subjects.

Metered-Dose Inhalers. The MDIs used in this experiment were prepared daily in our

Pulmonary Aerosol Deposition

Dose. The mean (± SD) dose deposited in the lungs and oropharynx from one MDI puff expressed in microliters and as a percentage of the puff volumes are given in Table 3 for both the normal and bronchitic subjects, with the breath-actuated device (Aerochamber) and with the MDI alone. The dose deposited in the lungs and oropharynx was the same for both the normal and bronchitic subjects when the MDI was used alone (lungs, 4.42μ1 vs 3.67μ1 [p = 0.46]; throat, 30.0μ1 vs 27.8μ1 [p = 0.58]) or with

DISCUSSION

The use of the breath-actuated device (Aerochamber) to aid the delivery of a pressurized aerosol yielded the same lower airway dose as direct MDI use in both normal subjects and subjects with obstructive airway disease.14 In contrast, deposition of aerosol in the upper respiratory tract was decreased, on average, 14-fold by use of the device (Aerochamber). This is due to impaction of the larger high-velocity particles from the MDI on the chamber walls and evaporation of the remaining suspended

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Manuscript received September 22; revision accepted December 28.

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