[The evaluation of the relationship between the residual fluticasone propionate dry powder after inhalation and maximum peak inspiratory flow].
We often find some residual Fluticasone propionate (FP) dry powder after using a specialized inhalant instrument (Diskhaler) in daily clinical use. In this study, we evaluated the relationship between residual powder and peak inspiratory flow (PIF), and the therapeutic necessity of using the reductive method of the residual powder.


METHODS
70 patients with bronchial asthma including 18 patients concurrently with COPD were measured for their maximum PIF, the residual dose of FP dry powder and FP content of the residual powder after inhalation. We also investigated effective methods to reduce residual powder.


RESULTS
The residual powder volume may be dependently affected by maximum PIF. More than 50% residual powder after 1 inhalation occurred in asthmatic patients with a PIF of less than 50 L/min. Discovering almost the same FP content of dry powder residues as before inhalation, we recognized the therapeutic significance of the decreased residual dry powder. Although the method of increased inhalation frequency alone was limited, the combined use of nail-tapping vibration of the Diskhaler and increased inhalation frequency may significantly decrease the residual dry powder. After carrying out the nail-tapping vibration method over 3 months, we obtained significant increases in daily Peak expiratory flow values with no increased pharyngeal Candidiasis. Oral abnormal dry sensation was found in one person as an additional side effect.


CONCLUSIONS
We showed the quantitative evaluation of the relationship between PIF and residual FP dose, while making clear the therapeutic meaning of the reduction of residual powder. Our nail-tapping method may be a clinically effective method to reduce risidual FP dry powder.
Ohbayashi
Hiroyuki
H
JA Gifu-Kouseiren Showa Hospital. ohbayasi@nn.iij4u.or.jp
Yamase
Hirohiko
H
D000368:Aged; D000730:Androstadienes / Q000008:administration & dosage*; D018926:Anti-Allergic Agents / Q000008:administration & dosage*; D001249:Asthma / Q000188:drug therapy; D005260:Female; D000068298:Fluticasone; D006801:Humans; D008297:Male; D009330:Nebulizers and Vaporizers; D010366:Peak Expiratory Flow Rate / Q000502:physiology*; D011208:Powders
D000730:Androstadienes; D018926:Anti-Allergic Agents; D011208:Powders; D000068298:Fluticasone