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Davis MD, Saunders JL, Crandall CN, Engberg RJ, Zhao Y, DiBlasi R, Rubin BK. In vitro-in vivo correlation of aerosol deposition before and after metered-dose inhaler coaching in healthy children. J Breath Res 2023; 17. [PMID: 36996807 DOI: 10.1088/1752-7163/acc8f1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/30/2023] [Indexed: 04/01/2023]
Abstract
Although pressurized metered dose inhaler (pMDI) education is a routine part of childhood asthma management and encouraging "optimal breathing patterns" (i.e., slowly, deeply, completely, and with a mouth seal on the mouthpiece) is an integral part of recommended pMDI education, there is currently no quantifiable way to determine if a child is inhaling their medication correctly or optimally through a valved holding chamber (VHC). The TipsHaler™ (tVHC) is a prototype VHC device that measures inspiratory time, flow, and volume without changing the properties of the medication aerosol. The measurements in vivo recorded by the tVHC can be downloaded and transferred to a spontaneous breathing lung model to simulate the inhalational patterns in vitro and also determine the deposition of inhaled aerosol mass with each pattern. We hypothesized that pediatric patients' inhalational patterns when using a pMDI would improve after active coaching via tVHC. This would increase the pulmonary deposition of inhaled aerosols in an in vitro model. To test this hypothesis, we conducted a single-site, prospective, pilot, pre-and-post intervention study paired with a bedside-to-bench experiment. Healthy, inhaler-naïve subjects used a placebo inhaler in conjunction with the tVHC before and after coaching and recorded inspiratory parameters. These recordings were then implemented into a spontaneous breathing lung model during albuterol MDI delivery, and pulmonary deposition of albuterol was quantified. In this pilot study, active coaching resulted in a statistically significant increase in inspiratory time (n = 8, p = 0.0344, 95%CI: 0.082 to ∞). tVHC recorded inspiratory parameters obtained from patients were successfully implemented in the in vitro model, which demonstrated that both inspiratory time (n = 8, r = 0.78, p < 0.001, 95%CI: 0.47 to 0.92) and volume (n = 8, r = 0.58, p = 0.0186, 95%CI: 0.15 to 0.85) strongly correlate with pulmonary deposition of inhaled drugs.
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Affiliation(s)
- Michael D Davis
- Pulmonary Medicine, Herman B Wells Center for Pediatric Research, 1044 West Walnut Street R4-472, Indianapolis, Indiana, 46202, UNITED STATES
| | - Jessica L Saunders
- Pulmonology, Allergy, and Sleep Medicine, Riley Hospital for Children, 705 Riley Hospital Drive, Indianapolis, Indiana, 46202, UNITED STATES
| | - Coral N Crandall
- Seattle Children's Research Institute, 1900 9th Avenue, Seattle, Washington, 98101-1309, UNITED STATES
| | - Rebecca J Engberg
- Seattle Children's Research Institute, 1900 9th Avenue, Seattle, Washington, 98101-1309, UNITED STATES
| | - Yi Zhao
- Biostatistics, Indiana University School of Medicine, 340 W. 10th Street, Indianapolis, Indiana, 46202-5114, UNITED STATES
| | - Rob DiBlasi
- Seattle Children's Research Institute, 1900 9th Avenue, Seattle, Washington, 98101-1309, UNITED STATES
| | - Bruce K Rubin
- Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, 1001 E. Marshall Street, Richmond, Virginia, 23298, UNITED STATES
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