title: Safety of inhaled corticosteroids delivered by plastic and metal spacers.
abstract: BACKGROUND
  Because of its non-electrostatic properties the metal Nebuchamber (NC) valved holding chamber (VHC) delivers a greater mass of aerosol to the mouth than the polypropylene Aerochamber (AC) VHC. Delivery of more aerosol to the lungs may also increase systemic absorption of inhaled corticosteroids (ICS) and hypothalamo-pituitary-adrenal (HPA) suppression.
  
  
  METHODS
  Thirty children (mean 4.3 (SD 0.3) years) received 200 micro g budesonide twice daily by NC or AC, both with the mask provided, in a randomised, two month crossover trial. Twenty four hour urinary free cortisol (UFC) was determined as a measure of HPA suppression.
  
  
  RESULTS
  UFC decreased from 42.3 (7.8) nmol UFC/nmol creatinine control to 26.2 (2.4) (p = 0.06 v control) after AC, and to 24.5 (2.5) (p = 0.04 v control) after NC (p = 0.4 AC v NC).
  
  
  CONCLUSIONS
  Despite a greater total dose delivered to the mouth, NC is not associated with greater HPA suppression when using 400 micro g/day budesonide under real life conditions in young children.
authors.affiliation: IPROS Network of the Israel Ambulatory Pediatric Association and Schneider Children's Medical Centre of Israel. amirav@012.net.il
authors.forename: I
authors.initials: I
authors.lastname: Amirav
authors.forename: Y
authors.initials: Y
authors.lastname: Mansour
authors.forename: T
authors.initials: T
authors.lastname: Tiosano
authors.forename: S
authors.initials: S
authors.lastname: Chamny
authors.forename: S
authors.initials: S
authors.lastname: Chirurg
authors.forename: S
authors.initials: S
authors.lastname: Oren
authors.forename: Z
authors.initials: Z
authors.lastname: Grossman
authors.forename: L
authors.initials: L
authors.lastname: Kahana
authors.forename: E
authors.initials: E
authors.lastname: Kahan
authors.forename: M T
authors.initials: MT
authors.lastname: Newhouse
mesh_terms: D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000494:pharmacology; D001249:Asthma / Q000188:drug therapy* / Q000652:urine; D001993:Bronchodilator Agents / Q000008:administration & dosage* / Q000494:pharmacology; D019819:Budesonide / Q000008:administration & dosage* / Q000494:pharmacology; D002648:Child; D002675:Child, Preschool; D018592:Cross-Over Studies; D006801:Humans; D006854:Hydrocortisone / Q000652:urine; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects; D036503:Inhalation Spacers; D010913:Pituitary-Adrenal System / Q000187:drug effects; D011126:Polypropylenes; D013193:Stainless Steel
chemical_list: D000893:Anti-Inflammatory Agents; D001993:Bronchodilator Agents; D011126:Polypropylenes; D013193:Stainless Steel; D019819:Budesonide; D006854:Hydrocortisone