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Valved Holding Chamber Increases Delivery of Fluticasone in Metered-Dose Inhaler for Children Across Age Groups: Presented at AAAAI By Paula Moyer MIAMI BEACH, FL -- March 7, 2006 -- Use of a valved holding chamber (VHC) increases the delivery of fluticasone (Flovent) in children with asthma across age groups, according to investigators who presented findings here at the 62nd annual meeting of the American Academy of Allergy, Asthma, and Immunology (AAAAI). In a presentation on March 5th, principal investigator Yasmeen R. Kahn, MD, said she and her co-investigators had hypothesized that delivery of fluticasone by passively inhaling through a VHC would result in less deposition of fluticasone in the airways than with the technique-dependent method of inhaling deeply and holding the breath. The latter method is taught to older children, while the VHC is used with children younger than 5 years, for whom the VHC is attached to the mouthpiece of the metered dose inhaler. "The VHC increases delivery of fluticasone where a mask or mouthpiece is used," said Dr. Khan, Allergy Fellow, University of Florida, Gainesville, Florida, United States. "There was no age-related effect." In their study, Dr. Khan and colleagues used inhalers containing fluticasone with the propellant hydrofluoroalkane (HFA). The investigators used the 1-hour steady-state fluticasone plasma concentration as a way to measure indirectly the relative amount of drug deposited in the lungs and to measure directly the systemic exposure. They recruited 60 children, 2.1 to 18 years old, who had adequately controlled persistent asthma. The children received two inhalations of 110 mcg of fluticasone twice daily for at least 3 days through an HFA metered dose inhaler through a device with which they demonstrated proficiency. Dr. Khan noted that this dose, which is considered relatively high, is given routinely in her office. The study design required 100% adherence with the regimen, which the investigators documented with an electronic monitor. The investigators then studied five groups of 12 patients: 12-18 year olds who used the inhaler alone; 5-9 year olds who used the inhaler alone; 5-9 year olds who used a VHC with a mouthpiece; 5-9 year olds who used a VHC with a mask; and 1-4 year olds who used a VHC with a mask. The investigators measured fluticasone with an assay designed for precision at 5 pg/mL. Average concentrations were: 76 pg/mL for the 12- to 18-year-olds on inhaler alone; 87 pg/mL for the 5-9 year olds on inhaler alone; 207 pg/mL for the 5-9 year olds using the VHC with a mouthpiece; 140 pg/mL for the 5-9 year olds using the VHC with a mask; 165 pg/mL for the 1-4 year olds using the VHC with a mask. The average concentration in the adolescents using the inhaler alone was significantly lower than all of the groups using a VHC (P =.003). However, it was not different from the 5-9 year olds using the inhaler alone. The findings showed that the VHC improved deposition of fluticasone across age groups, Dr. Khan said. The VHC improved deposition of fluticasone regardless of whether children breathed through a mask or a mouthpiece, and compensated for passive inhalation in the youngest group of children, she said. The study was funded by GlaxoSmithKline, which manufactures Flovent. [Presentation title: Relative Amount of Fluticasone Delivered by HFA-MDI to Children of Different Ages. Abstract 354] E-mail this page to a friend or colleague! To print, use this version