Purpose
To determine the effect of the oropharyngeal length in adults on the lung dose of a suspension pressurized metered dose inhaler, and whether employing small volume spacers can alter this role.
Methods
Depositions of Ventolin™ Evohaler™ (100) μg in the oropharyngeal models of two healthy adult subjects with 17.1 cm (short cast) and 19.9 cm (long cast) centerline lengths via three small volume spacers [two spacers with 3 cm effective length but one with 6.5 cm2 (L3) and the other with 24.6 cm2 (L3W) cross sections, and the Optimiser] were studied.
Results
Without using spacers, lung dose of the long cast (19.52 ± 2.32 μg, mean ± standard deviation) was significantly larger than that for the short cast (8.08 ± 1.01 μg, p < 0.006). However, using the L3 spacer with the short cast made the lung dose (18.59 ± 3.33 μg) similar to that for the long cast alone. Lung doses of the short cast (20.43 ± 1.42 μg) and the long cast (30.81 ± 1.84 μg) with the L3W spacer were similar to those with the L3 spacer. However, using the Optimiser spacer increased the lung dose for the short cast (22.27 ± 6.03 μg) and significantly for the long cast (35.61 ± 2.19 μg, p < 0.006) compared to those for the L3 spacer. Using spacers increased drug deposition in the oropharynx part of the short cast, and this reduced the lung dose compared to that for the long cast.
Conclusion
The oropharyngeal length in adults may affect the lung dose via the pMDIs, which may not be eliminated by using small volume spacers.
Similar content being viewed by others
References
A. J. Hickey R. M. Evans (1996) Aerosol generation from propellant-driven metered dose inhalers A. J. Hickey (Eds) Inhalation Aerosols, Vol. 94 Marcel Dekker New York 417–439
H. D. Smyth (2003) ArticleTitleThe influence of formulation variables on the performance of alternative propellant-driven metered dose inhalers Adv. Drug Deliv. Rev. 55 807–828 Occurrence Handle12842602 Occurrence Handle1:CAS:528:DC%2BD3sXkvFeksbY%3D Occurrence Handle10.1016/S0169-409X(03)00079-6
P. W. Barry C. O'Callaghan (1997) ArticleTitleIn vitro comparison of the amount of salbutamol available for inhalation from different formulations used with different spacer devices Eur. Respir. J. 10 1345–1348 Occurrence Handle9192941 Occurrence Handle1:CAS:528:DyaK2sXksVKis7c%3D Occurrence Handle10.1183/09031936.97.10061345
A. R. Clark (1996) ArticleTitleMDIs: physics of aerosol formation J. Aerosol Med. 9 S19–S26 Occurrence Handle10160054
S. Newman G. Pitcairn K. Steed A. Harrison J. Nagel (1999) ArticleTitleDeposition of fenoterol from pressurized metered dose inhalers containing hydrofluoroalkanes J. Allergy Clin. Immunol. 104 S253–S257 Occurrence Handle10588986 Occurrence Handle1:CAS:528:DC%2BD3cXjt1ynsg%3D%3D Occurrence Handle10.1016/S0091-6749(99)70042-4
C. L. Leach P. J. Davidson B. E. Hasselquist R. J. Boudreau (2002) ArticleTitleLung deposition of hydrofluoroalkane-134a beclomethasone is greater than that of chlorofluorocarbon fluticasone and chlorofluorocarbon beclomethasone: a cross-over study in healthy volunteers Chest 122 510–516 Occurrence Handle12171824 Occurrence Handle1:CAS:528:DC%2BD38XntFSktb4%3D Occurrence Handle10.1378/chest.122.2.510
E. Berg J. Madsen H. Bisgaard (1998) ArticleTitleIn vitro performance of three combinations of spacers and pressurized metered dose inhalers for treatment in children Eur. Respir. J. 12 472–476 Occurrence Handle9727804 Occurrence Handle1:STN:280:DyaK1czpsVOrtQ%3D%3D Occurrence Handle10.1183/09031936.98.12020472
R. N. Dalby A. J. Hickey S. L. Tiano (1996) Medical devices for the delivery of therapeutic aerosols to the lungs A. J. Hickey (Eds) Inhalation Aerosols, Vol. 94 Marcel Dekker New York 441–473
S. P. Newman K. P. Steed G. Hooper J. I. Jones F. C. Upchurch (1999) ArticleTitleImproved targeting of beclomethasone diproprionate (250 μg metered dose inhaler) to the lungs of asthmatics with the Spacehaler™ Respir. Med. 93 424–431 Occurrence Handle10464826 Occurrence Handle1:STN:280:DyaK1MzpsVSqsA%3D%3D Occurrence Handle10.1053/rmed.1999.0587
G. R. Dickens D. P. Wermeling C. J. Matheny W. John W. Abramowitz S. M. Sista T. Foster S. Choudhury (2000) ArticleTitlePharmacokinetics of flunisolide administered via metered dose inhaler with and without a spacer device and following oral administration Ann. Allergy Asthma Immunol. 84 528–532 Occurrence Handle10831007 Occurrence Handle1:CAS:528:DC%2BD3MXhtVeksL0%3D Occurrence Handle10.1016/S1081-1206(10)62517-3
P. H. Hirst G. R. Pitcairn J. C. Richards S. Rohatagi M. S. Gillen S. P. Newman (2001) ArticleTitleDeposition and pharmacokinetics of an HFA formulation of triamcinolone acetonide delivered by pressurized metered dose inhaler J. Aerosol Med. 14 155–165 Occurrence Handle11681648 Occurrence Handle1:CAS:528:DC%2BD3MXmsVyitLc%3D Occurrence Handle10.1089/08942680152484090
J. Richards P. Hirst G. Pitcairn S. Mahashabde W. Abramowitz A. Nolting S. P. Newman (2001) ArticleTitleDeposition and pharmacokinetics of flunisolide delivered from pressurized inhalers containing non-CFC and CFC propellants J. Aerosol Med. 14 197–208 Occurrence Handle11681651 Occurrence Handle1:CAS:528:DC%2BD3MXmsVyitbw%3D Occurrence Handle10.1089/08942680152484126
J. Anhoj L. Thorsson H. Bisgaard (2000) ArticleTitleLung deposition of inhaled drugs increases with age Am. J. Respir. Crit. Care Med. 162 1819–1822
L. Agertoft L. W. Laulund L. I. Harrison S. Pedersen (2003) ArticleTitleInfluence of particle size on lung deposition and pharmacokinetics of beclomethasone dipropionate in children Pediatr. Pulmonol. 35 192–199 Occurrence Handle12567387 Occurrence Handle1:STN:280:DC%2BD3s7is1CktA%3D%3D Occurrence Handle10.1002/ppul.10238
S. G. Devadason T. Huang S. Walker R. Troedson P. N. Souef ParticleLe (2003) ArticleTitleDistribution of technetium-99m-labelled QVAR delivered using an Autohaler device in children Eur. Respir. J. 21 1007–1011 Occurrence Handle12797496 Occurrence Handle1:CAS:528:DC%2BD3sXltVKjt7o%3D Occurrence Handle10.1183/09031936.03.00087803
N. C. Miller A. M. Purrington (1996) ArticleTitleA cascade impactor entry port for MDI sprays with collection characteristics imitating a physical model of the human throat Pharm. Res. 13 391–397 Occurrence Handle8692731 Occurrence Handle1:CAS:528:DyaK28XhvVOiurk%3D Occurrence Handle10.1023/A:1016040509063
P. B. Myrdal S. W. Stein E. Mogalian W. Hoye A. Gupta (2004) ArticleTitleComparison of the TSI Model 3306 Impactor Inlet with the Andersen Cascade Impactor: solution metered dose inhalers Drug Dev. Ind. Pharm. 30 859–868 Occurrence Handle15521331 Occurrence Handle1:CAS:528:DC%2BD2cXotVektLw%3D Occurrence Handle10.1081/DDC-200034575
E. Mogalian P. B. Myrdal (2005) ArticleTitleApplication of USP inlet extensions to the TSI impactor system 3306/3320 using HFA 227 based solution metered dose inhalers Drug Dev. Ind. Pharm. 31 977–985 Occurrence Handle16316853 Occurrence Handle1:CAS:528:DC%2BD2MXht1GltLvN Occurrence Handle10.1080/03639040500306211
W. Hofmann T. B. Martonen R. C. Graham (1989) ArticleTitlePredicted deposition of nonhygroscopic aerosols in the human lung as a function of subject age J. Aerosol Med. 2 49–68 Occurrence Handle10.1089/jam.1989.2.49
M. J. Oldham R. C. Mannix R. F. Phalen (1997) ArticleTitleDeposition of monodisperse particles in hollow models representing adult and child-size tracheobronchial airways Health Phys. 72 827–834 Occurrence Handle9169924 Occurrence Handle1:CAS:528:DyaK2sXjsVOkt7k%3D Occurrence Handle10.1097/00004032-199706000-00001
W. H. Finlay C. F. Lange M. King D. P. Speert (2000) ArticleTitleLung delivery of aerosolized dextran Am. J. Respir. Crit. Care Med. 161 91–97 Occurrence Handle10619803 Occurrence Handle1:STN:280:DC%2BD3c%2Foslehuw%3D%3D
R. F. Phalen M. J. Oldham C. B. Beaucage T. T. Crocker J. Mortensen (1985) ArticleTitlePostnatal enlargement of human tracheobronchial airways and implications for particle deposition Anat. Rec. 212 368–380 Occurrence Handle4073554 Occurrence Handle1:STN:280:DyaL28%2FnsFWjtQ%3D%3D Occurrence Handle10.1002/ar.1092120408
R. F. Phalen M. J. Oldham (2001) ArticleTitleMethods for modeling particle deposition as a function of age Respir. Physiol. 128 119–130 Occurrence Handle11535268 Occurrence Handle1:STN:280:DC%2BD3MvptlOnsQ%3D%3D Occurrence Handle10.1016/S0034-5687(01)00270-5
R. P. Subramaniam B. Asgharian J. I. Freijer F. J. Miller S. Anjilvel (2003) ArticleTitleAnalysis of lobar differences in particle deposition in the human lung Inhal. Toxicol. 15 1–21 Occurrence Handle12476357 Occurrence Handle1:CAS:528:DC%2BD38XpslGls7k%3D Occurrence Handle10.1080/08958370304451
P. H. Hirst G. R. Pitcairn J. G. Weers T. E. Tarara A. R. Clark L. A. Dellamary G. Hall J. Shorr S. P. Newman (2002) ArticleTitleIn vivo lung deposition of hollow porous particles from a pressurized metered dose inhaler Pharm. Res. 19 258–264 Occurrence Handle11934231 Occurrence Handle1:CAS:528:DC%2BD38XisFGgurc%3D Occurrence Handle10.1023/A:1014482615914
L. Borgstrom T. Bengtsson E. Derom R. Pauwels (2000) ArticleTitleVariability in lung deposition of inhaled drug, within and between asthmatic patients, with a pMDI and a dry powder inhaler, Turbuhaler Int. J. Pharm. 193 227–230 Occurrence Handle10606786 Occurrence Handle1:CAS:528:DyaK1MXnvFSlt7w%3D Occurrence Handle10.1016/S0378-5173(99)00341-5
T. Ehtezazi M. A. Horsfield P. W. Barry C. O'Callaghan (2004) ArticleTitleDynamic change of the upper airway during inhalation via aerosol devices J. Aerosol Med. 17 325–334 Occurrence Handle15684732 Occurrence Handle10.1089/jam.2004.17.325
G. Rudolf R. Köbrich W. Stahlhofen (1990) ArticleTitleModeling and algebraic formulation of regional deposition in man J. Aerosol Sci. 21 S403–S406 Occurrence Handle10.1016/0021-8502(90)90266-Z
A. R. Clark S. P. Newman N. Dasovich (1998) ArticleTitleMouth and oropharyngeal deposition of pharmaceutical aerosols J. Aerosol Med. 11 S116–S121 Occurrence Handle10180723
C. S. Kim M. A. Eldridge M. A. Sackner (1987) ArticleTitleOropharyngeal deposition and delivery aspects of metered-dose inhaler aerosols Am. Rev. Respir. Dis. 135 157–164 Occurrence Handle3800143 Occurrence Handle1:STN:280:DyaL2s%2FpvVaisQ%3D%3D
S. W. Stein B. J. Gabrio (2000) Understanding throat deposition during cascade impaction testing P. R. Byron R. N. Dalby S. J. Farr J. Peart (Eds) Respiratory Drug Delivery VII Serentec Press Raleigh, NC 287–290
Y. S. Cheng C. S. Fu D. Yazzie Y. Zhou (2001) ArticleTitleRespiratory deposition patterns of salbutamol pMDI with CFC and HFA-134a formulations in a human airway replica J. Aerosol Med. 14 255–266 Occurrence Handle11681657 Occurrence Handle1:CAS:528:DC%2BD3MXmsVyitbk%3D Occurrence Handle10.1089/08942680152484180
T. Ehtezazi K. W. Southern D. Allanson I. Jenkinson C. O'Callaghan (2005) ArticleTitleSuitability of the upper airway models obtained from MRI studies in simulating drug lung deposition from inhalers Pharm. Res. 22 166–170 Occurrence Handle15771244 Occurrence Handle1:CAS:528:DC%2BD2MXhtlClu7o%3D Occurrence Handle10.1007/s11095-004-9023-1
K. Svartengren P. Lindestad M. Svartengren K. Philipson G. Bylin P. Camner (1995) ArticleTitleAdded external resistance reduces oropharyngeal deposition and increases lung deposition of aerosol particles in asthmatics Am. J. Respir. Crit. Care Med. 152 32–37 Occurrence Handle7599841 Occurrence Handle1:STN:280:DyaK2MzitlWqsA%3D%3D
C. O'Callaghan J. Lynch M. Cant C. Robertson (1993) ArticleTitleImprovement in sodium cromoglycate delivery from a spacer device by use of an antistatic lining, immediate inhalation, and avoiding multiple actuations of drug Thorax 48 603–606 Occurrence Handle8346488 Occurrence Handle10.1136/thx.48.6.603
J. H. Wildhaber G. W. Waterer G. L. Hall Q. A. Summers (2000) ArticleTitleReducing electrostatic charge on spacer devices and bronchodilator response Br. J. Clin. Pharmacol. 50 277–280 Occurrence Handle10971314 Occurrence Handle1:STN:280:DC%2BD3M%2FhvVOmug%3D%3D Occurrence Handle10.1046/j.1365-2125.2000.00251.x
B. Olsson L. Borgstrom L. Asking E. Bondesson (1996) Effect of inlet throat on the correlation between measured fine particle dose and lung deposition R. N. Dalby P. R. Byron S. J. Farr (Eds) Respiratory Drug Delivery V Interpharm Press Buffalo Grove, IL 273–281
R. Janssen M. Weda M. B. Ekkelenkamp J. W. Lammers P. Zanen (2002) ArticleTitleMetal versus plastic spacers: an in vitro and in vivo comparison Int. J. Pharm. 245 93–98 Occurrence Handle12270246 Occurrence Handle1:CAS:528:DC%2BD38XntFygsr0%3D Occurrence Handle10.1016/S0378-5173(02)00330-7
M. Crampton R. Kinnersley J. Ayres (2004) ArticleTitleSub-micrometer particle production by pressurized metered dose inhalers J. Aerosol Med. 17 33–42 Occurrence Handle15120011 Occurrence Handle1:CAS:528:DC%2BD2cXjtFaks7s%3D Occurrence Handle10.1089/089426804322994442
C. Dytham. Choosing and Using Statistics. A Biologist's Guide, Blackwell, 2003.
M. Bland. An Introduction to Medical Statistics, Oxford University Press, 2000.
J. C. Dubus C. Marguet A. Deschildre L. Mely P. Roux ParticleLe J. Brouard L. Huiart (2001) ArticleTitleLocal side-effects of inhaled corticosteroids in asthmatic children: influence of drug, dose, age, and device Allergy 56 944–948 Occurrence Handle11576072 Occurrence Handle1:CAS:528:DC%2BD3MXnsFWhsrY%3D Occurrence Handle10.1034/j.1398-9995.2001.00100.x
A. M. Wilson H. J. Brewster B. J. Lipworth (1998) ArticleTitleDose-response comparison of systemic bioactivity with inhaled budesonide and triamcinolone acetonide in asthmatic adults J. Allergy Clin. Immunol. 102 751–756 Occurrence Handle9819291 Occurrence Handle1:CAS:528:DyaK1cXotVehs70%3D Occurrence Handle10.1016/S0091-6749(98)70014-4
A. F. Heenan E. Matida A. Pollard W. H. Finlay (2003) ArticleTitleExperimental measurements and computational modeling of the flow field in an idealized human oropharynx Exp. Fluids 35 70–84 Occurrence Handle10.1007/s00348-003-0636-7
O. Aswania H. Chrystyn (2001) ArticleTitleRelative lung bioavailability of generic sodium cromoglycate inhalers used with and without a spacer device Pulm. Pharmacol. Ther. 14 129–133 Occurrence Handle11273794 Occurrence Handle1:CAS:528:DC%2BD3MXitFyltb0%3D Occurrence Handle10.1006/pupt.2001.0279
P. H. Hirst R. E. Bacon G. R. Pitcairn M. Silvasti S. P. Newman (2001) ArticleTitleA comparison of the lung deposition of budesonide from Easyhaler, Turbuhaler and pMDI plus spacer in asthmatic patients Respir. Med. 95 720–727 Occurrence Handle11575892 Occurrence Handle1:STN:280:DC%2BD3MrivFOquw%3D%3D Occurrence Handle10.1053/rmed.2001.1107
C. Leach (1999) ArticleTitleEffect of formulation parameters on hydrofluoroalkane-beclomethasone dipropionate drug deposition in humans J. Allergy Clin. Immunol. 104 S250–S252 Occurrence Handle10588985 Occurrence Handle1:CAS:528:DC%2BD3cXjt1ygug%3D%3D Occurrence Handle10.1016/S0091-6749(99)70041-2
Acknowledgments
The original MRI data to manufacture the upper airway (oropharyngeal) models was obtained from a study that was sponsored by AstraZeneca R&D Charnwood, and this study was reported in Ref. 27. We would also like to thank Mr. Anthony Dunmore for technical assistance.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ehtezazi, T., Allanson, D.R., Jenkinson, I.D. et al. Effect of Oropharyngeal Length in Drug Lung Delivery via Suspension Pressurized Metered Dose Inhalers. Pharm Res 23, 1364–1372 (2006). https://doi.org/10.1007/s11095-006-0163-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11095-006-0163-3