title: Salmeterol administration by metered-dose inhaler alone vs metered-dose inhaler plus valved holding chamber.
abstract: OBJECTIVE
  To determine whether a spacer device designed as a valved holding chamber with a flow signal increases the efficacy of the long-acting beta(2)-agonist, salmeterol, in patients who use incorrect technique with metered-dose inhaler (MDI) alone.
  
  
  METHODS
  Double-blind, randomized, placebo-controlled study.
  
  
  METHODS
  University hospital outpatient rooms.
  
  
  METHODS
  Twenty adult outpatients with stable persistent asthma, receiving a daily anti-inflammatory drug.
  
  
  METHODS
  Patients were randomized to either salmeterol MDI (incorrect use: 1 s after actuating MDI, inhale rapidly) and placebo plus spacer (correct use: inhale slowly as MDI is actuated, continue to inhale slowly and deeply) or placebo MDI (incorrect use) and salmeterol plus spacer (correct use). The following week, patients received the opposite treatment. The dose was two puffs from each device on each treatment day; each puff was separated by 1 min.
  
  
  RESULTS
  After baseline peak expiratory flow (PEF), salmeterol was administered and serial PEF determined (0.5, 1, 2, 3, 4, 6, 8, 10, and 12 h). Administration of salmeterol MDI plus spacer resulted in significantly greater increases in PEF from baseline vs MDI at 4 h (44 L/min vs 10 L/min; p < 0.01) and 6 h (49 L/min vs 24 L/min; p < 0.05). Both methods of administration were equally well tolerated.
  
  
  CONCLUSIONS
  We conclude that patients who have poor timing and rapid inhalation with salmeterol MDI alone will have greater increases in PEF at 4 h and 6 h and no additional side effects if the dose is administered with a valved holding chamber that is used correctly. Further study is needed regarding other errors in MDI technique with salmeterol.
authors.affiliation: Department of Clinical Pharmacy, University of Tennessee, Memphis 38163, USA.
authors.forename: K
authors.initials: K
authors.lastname: Demirkan
authors.forename: E
authors.initials: E
authors.lastname: Tolley
authors.forename: T
authors.initials: T
authors.lastname: Mastin
authors.forename: J
authors.initials: J
authors.lastname: Soberman
authors.forename: J
authors.initials: J
authors.lastname: Burbeck
authors.forename: T
authors.initials: T
authors.lastname: Self
mesh_terms: D000328:Adult; D000368:Aged; D000403:Airway Resistance / Q000187:drug effects; D000420:Albuterol / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D001993:Bronchodilator Agents / Q000008:administration & dosage* / Q000009:adverse effects; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009330:Nebulizers and Vaporizers; D010366:Peak Expiratory Flow Rate / Q000187:drug effects; D000068299:Salmeterol Xinafoate; D016896:Treatment Outcome
chemical_list: D001993:Bronchodilator Agents; D000068299:Salmeterol Xinafoate; D000420:Albuterol