High dose steroid inhalation therapy using a large spacer: laboratory and clinical study on usefulness of the 4-puffs/inhalation method

• Published in: Nihon Kyōbu Shikkan Gakkai zasshi Vol. 31; no. 10; p. 1235
• Main Authors: Yamagishi, M, Tanaka, H, Yokogawa, K, Sugaya, F, Honma, S, Honma, A, Shijubo, N, Abe, S
• Format: Journal Article
• Language: English; Japanese
• Published: Japan 01-10-1993
• Subjects: Adult; Asthma - drug therapy; Beclomethasone - administration & dosage; Beclomethasone - pharmacokinetics; Chronic Disease; Evaluation Studies as Topic; Female; Humans; Lung - metabolism; Male; Middle Aged; Respiratory Therapy - methods
• ISSN: 0301-1542
• DOI: 10.11389/jjrs1963.31.1235

We investigated whether or not the inhalation method of beclomethasone dipropionate (BDP) influences patient compliance and the clinical effects of therapy in chronic bronchial asthma, together with a basic study on the lung deposition of BDP using a twin Impinger when various numbers of puffs were discharged into three different spacers (Volumatic, InspirEase, Aerochamber). It was clearly shown that only the spacer, Volumatic maintained a high deposition rate of BDP in the lung model with a dose of 4-puffs/inhalation. Eighteen chronic asthmatic patients were studied. The patients inhaled BDP (800-1600 micrograms/day) by 1-puff/inhalation using a large spacer, Volumatic, for 12 weeks, and they then inhaled the same dose of BDP as given in the previous period by 4-puffs/inhalation using the spacer for 16 weeks. We compared the compliance of BDP, attack score, %PEFR and frequency of beta-agonist inhalation between these two periods. The compliance of BDP was markedly improved after changing from 1-puff/inhalation (92.8%) to 4-puffs/inhalation (99.8%). In the 4-puffs/inhalation period, attack score and %PEFR were significantly improved as compared to the 1-puff/inhalation period. The frequency of beta-agonist inhalation use in the 4-puffs/inhalation period was significantly lower than that in the 1-puff/inhalation period. These results indicate that when high dose steroid inhalation is given with a large spacer in chronic asthmatic patients, we should advice them of the appropriate inhalation method in order to obtain good compliance and clinical effects.