title: Lung deposition of fenoterol and flunisolide delivered using a novel device for inhaled medicines: comparison of RESPIMAT with conventional metered-dose inhalers with and without spacer devices.
abstract: OBJECTIVE
  To compare lung deposition of fenoterol or flunisolide administered from a novel, multidose inhalation device delivering liquid droplets (RESPIMAT; Boehringer Ingelheim Ltd; Bracknell, UK) or from conventional metered-dose inhalers (MDIs) with and without spacers.
  
  
  METHODS
  Two randomized, three-way crossover studies.
  
  
  METHODS
  Clinical research laboratory.
  
  
  METHODS
  Healthy, nonsmoking volunteers.
  
  
  METHODS
  In one study, radiolabeled aerosols of fenoterol from the RESPIMAT device and from a conventional MDI with or without an Aerochamber spacer (Trudell Medical; London, Ontario Canada). In the second study, radiolabeled aerosols of flunisolide from a RESPIMAT device, from a RESPIMAT device modified by inclusion of a baffle/impactor in the mouthpiece, and from a conventional MDI with an Inhacort spacer (Boehringer Ingelheim; Ingelheim, Germany).
  
  
  RESULTS
  Assessment of the deposition of fenoterol or flunisolide in the lung and oropharynx using gamma scintigraphy. Safety was assessed based on reported adverse effects and spirometry (FEV1, FVC, and peak expiratory flow rate) to detect any paradoxical bronchoconstriction. The RESPIMAT device delivered significantly more fenoterol to the lungs than either an MDI alone or an MDI with Aerochamber (39.2% vs 11.0% and 9.9% of metered dose, respectively; p<0.01). Oropharyngeal deposition of fenoterol from the new device was lower than that from the MDI (37.1% vs 71.7%, respectively; p<0.01). The RESPIMAT device deposited significantly more flunisolide in the lungs compared with MDI plus spacer (44.6% vs 26.4%, respectively; p<0.01), while resulting in similar oropharyngeal deposition (26.2% vs 31.2%, respectively). Introduction of a baffle into the RESPIMAT system reduced lung deposition of flunisolide to 29.5%, and oropharyngeal deposition to 7.8% (p<0.01).
  
  
  CONCLUSIONS
  The RESPIMAT device may prove to be an effective alternative to MDIs for the administration of inhaled bronchodilators and corticosteroids. The high lung deposition and low oropharyngeal deposition may lead to improved efficacy and tolerability of inhaled medications, especially corticosteroids.
authors.affiliation: Pharmaceutical Profiles Limited, Nottingham, UK.
authors.forename: S P
authors.initials: SP
authors.lastname: Newman
authors.forename: J
authors.initials: J
authors.lastname: Brown
authors.forename: K P
authors.initials: KP
authors.lastname: Steed
authors.forename: S J
authors.initials: SJ
authors.lastname: Reader
authors.forename: H
authors.initials: H
authors.lastname: Kladders
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D018592:Cross-Over Studies; D016503:Drug Delivery Systems; D004867:Equipment Design; D005260:Female; D005280:Fenoterol / Q000008:administration & dosage*; D005446:Fluocinolone Acetonide / Q000008:administration & dosage / Q000031:analogs & derivatives*; D006801:Humans; D008297:Male; D009330:Nebulizers and Vaporizers; D012129:Respiratory Function Tests
chemical_list: D000893:Anti-Inflammatory Agents; D001993:Bronchodilator Agents; D005446:Fluocinolone Acetonide; D005280:Fenoterol; C007734:flunisolide