In Vitro Performance of Valved Holding Chambers in Paediatric Asthma Controller Therapy

Abstract

Aim: Research on the drug delivery of inhaled corticosteroids and combination medications via valved holding chambers (VHCs) with children's breathing patterns is limited. We aimed to evaluate the in vitro performance of commercially available VHCs without facemasks under preschooler breathing conditions, focusing on total delivered dose and fine particle dose (FPD). Methods: We evaluated the FPD in 1–5 μm range of fluticasone/salmeterol combination inhaler, fluticasone propionate mono-inhaler, and ciclesonide delivered through three VHCs: AeroChamber Plus Flow-Vu, EasyChamber, and OptiChamber Diamond. Drug delivery was measured using a Next Generation Impactor with simulated breathing representative of a 4-year-old child. Results: The total delivered dose compared to the label claim was highest for ciclesonide with all the VHCs. The median FPD in 1–5 μm range was significantly higher with EasyChamber compared to AeroChamber and OptiChamber for salmeterol and fluticasone from combination-inhaler and ciclesonide. Overall, relative throat deposition was lowest for ciclesonide and highest for fluticasone mono-inhaler. OptiChamber yielded lowest relative throat depositions for ciclesonide and fluticasone mono-inhaler, while EasyChamber gave lowest relative throat depositions for salmeterol and fluticasone from combination inhaler. Conclusion: There were notable differences between the tested VHC's drug delivery. Ciclesonide exhibited favourable aerodynamic properties than fluticasone.