ABSTRACT
Achieving appropriate inhalation in patients with coronavirus disease 2019 (COVID-19) is a common challenge in the use of repurposed metered-dose inhaler (MDI) formulations. The purpose of this study was to evaluate the effect of five valved holding chambers (VHCs) on the inhalation of ciclesonide from Alvesco MDI. The aerodynamic particle size distribution of ciclesonide discharged from Alvesco MDI was evaluated using a Next Generation Impactor in the presence and absence of VHCs. The use of VHCs retained or slightly increased the amount of ciclesonide in the fine particle diameter range (aerodynamic particle size below 3 µm) (FPD) and reduced the amount at the induction port after coordinated inhalation. However, the use of VHC reduced the FPD of the formulation by increasing the time between the MDI discharge and the pump suction by various degrees among the five VHCs. These results indicated that use of the VHCs and minimizing the inhalation delay time should ensure sufficient inhalation of ciclesonide particles.
Subject(s)
COVID-19 Drug Treatment , Drug Repositioning , Inhalation Spacers , Metered Dose Inhalers , Pregnenediones/administration & dosage , Administration, Inhalation , Humans , Particle SizeABSTRACT
BACKGROUND: During the COVID-19 pandemic, a metered-dose inhaler (MDI) with a valved holding chamber (VHC) is a preferred route of bronchodilator delivery. We have developed a new homemade VHC, made of a paper coffee cup, and a drinking water bottle. This study was conducted to compare the bronchodilator response in children with airway hyperresponsiveness after the use of our homemade VHC and that of a standard commercial one. METHODS: In a randomized, two-period, two-sequence crossover trial, we recruited 20 children, aged 6-15 years, who had a greater than 12% increase in FEV1 after inhaled salbutamol. They were randomized into Group A and B. Group A used our VHC on the first day and Aerochamber® on the second day. Group B used the same VHCs but in alternate sequence. Spirometries were performed before and after 400 µg of salbutamol, MDI was administered via those VHCs. RESULTS: Baseline demographic data and spirometric values did not have statistically significant differences between group A and B and between the first and second day (p > .05). After giving salbutamol MDI, both VHCs produced significant increases in FVC, FEV1 , and FEF25-75% (p < .005). The improvement in FEV1 did not significantly differ between our homemade VHC and Aerochamber® (p > .05). CONCLUSION: Our homemade VHC is effective for an MDI bronchodilator delivery. Since it is very cheap and easy to make, it may be used as a disposable device to minimize airborne transmission especially when commercial VHC is not available.
Subject(s)
Albuterol/administration & dosage , Bronchodilator Agents/administration & dosage , Equipment Design , Metered Dose Inhalers , Respiratory Hypersensitivity/drug therapy , Administration, Inhalation , Adolescent , COVID-19 , Child , Cross-Over Studies , Female , Forced Expiratory Volume , Humans , Inhalation Spacers , Male , Pandemics , Respiratory Hypersensitivity/physiopathologyABSTRACT
Coronaviruses are a large family of viruses that infect humans, which may result in mild symptoms similar to those of the common cold. COVID-19 is most recent subtype similar or even worse than the two previous pandemic strains which were the severe acute respiratory syndrome coronavirus (SARS-CoV) and the Middle East respiratory syndrome coronavirus (MERS-CoV). The first cases of COVID-19 emerged in December 2019. Since then, the virus causing the disease has infected more than four million people around the globe and led to hundreds of thousands deaths. We think addressing the management of asthma in the era of this pandemic is important for several reasons: high prevalence of asthma in Saudi Arabia, further, majorities were uncontrolled disease. The statement will provide special instructions and answers to common questions of physicians dealing with asthmatic children during this pandemic.