title: Salbutamol delivery from a hydrofluoroalkane pressurized metered-dose inhaler in pediatric ventilator circuits: an in vitro study.
abstract: OBJECTIVE
  The aim of our study was to determine the in vitro delivery of salbutamol from a pressurized metered-dose inhaler (pMDI) containing hydrofluoroalkane (HFA) propellant through various delivery devices to four models of a pediatric lung.
  
  
  METHODS
  To determine the effect of electrostatic charge, delivery of salbutamol was initially assessed with a multistage liquid impinger (MSLI) through an inline nonchamber device (Baxter MDI Adapter) and a small (Aerochamber MV) and a large (Nebuhaler) inline chamber device. Following this, the delivery was assessed to four lung models appropriate for a child of 70 kg, 50 kg, 15 kg, and 4 kg, with the same three reduced static devices inserted directly into a pediatric ventilator circuit.
  
  
  RESULTS
  Reduction of electrostatic charge improved small particle delivery through holding chambers to the MSLI by 12 to 14%. In the ventilator model, the mean delivery was between 1.9% and 5.4% for the nonchamber device, between 14.3% and 27.2% for the small holding chamber, and between 7.2% and 25.7% for the large holding chamber. Delivery was the least efficient in the 4-kg model compared to the 70-kg, 50-kg, and 15-kg models.
  
  
  CONCLUSIONS
  Salbutamol from an HFA pMDI is delivered efficiently through inline holding chambers with reduced static in pediatric ventilator settings. A large holding chamber has no advantage over a small holding chamber. In addition, salbutamol delivery is more efficient through a holding chamber than through a nonchamber device.
authors.affiliation: Department of Respiratory Medicine, Princess Margaret Hospital for Children, Subiaco, Western, Australia. hannesw@cyllene.uwa.edu.au
authors.forename: J H
authors.initials: JH
authors.lastname: Wildhaber
authors.forename: M J
authors.initials: MJ
authors.lastname: Hayden
authors.forename: N D
authors.initials: ND
authors.lastname: Dore
authors.forename: S G
authors.initials: SG
authors.lastname: Devadason
authors.forename: P N
authors.initials: PN
authors.lastname: LeSouëf
mesh_terms: D000280:Administration, Inhalation; D000335:Aerosol Propellants / Q000008:administration & dosage*; D000420:Albuterol / Q000008:administration & dosage*; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D002648:Child; D016503:Drug Delivery Systems; D006801:Humans; D006845:Hydrocarbons, Fluorinated; D008168:Lung / Q000187:drug effects; D008953:Models, Anatomic; D009330:Nebulizers and Vaporizers; D012121:Respiration, Artificial / Q000379:methods; D055672:Static Electricity
chemical_list: D000335:Aerosol Propellants; D001993:Bronchodilator Agents; D006845:Hydrocarbons, Fluorinated; D000420:Albuterol