title: Force-dependent static dead space of face masks used with holding chambers.
abstract: BACKGROUND
  Pressurized metered-dose inhalers with valved holding chambers and masks are commonly used for aerosol delivery in children. Drug delivery can decrease when the dead-space volume (DSV) of the valved holding chamber is increased, but there are no published data evaluating force-dependent DSV among different masks.
  
  
  METHODS
  Seven masks were studied. Masks were sealed at the valved holding chamber end and filled with water to measure mask volume. To measure mask DSV we used a mannequin of 2-year-old-size face and we applied the mask with forces of 1.5, 3.5, and 7 pounds. Mask seal was determined by direct observation. Intra-brand analysis was done via analysis of variance.
  
  
  RESULTS
  At 3.5 pounds of force, the DSV ranged from 29 mL to 100 mL, with 3 masks having DSV of < 50 mL. The remaining masks all had DSV > 60 mL. At 3.5 pounds of force, DSV percent of mask volume ranged from 33.7% (Aerochamber, p < 0.01 compared with other masks) to 100% (Pocket Chamber). DSV decreased with increasing force with most of the masks, and the slope of this line was inversely proportional to mask flexibility. Mask fit was 100% at 1.5 pounds of force only with the Aerochamber and Optichamber. Mask fit was poorest with the Vortex, Pocket Chamber, and BreatheRite masks.
  
  
  CONCLUSIONS
  Rigid masks with large DSV might not be not suitable for use in children, especially if discomfort from the stiff mask makes its use less acceptable to the child.
authors.affiliation: Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1081, USA.
authors.forename: Samir A
authors.initials: SA
authors.lastname: Shah
authors.forename: Ariel B
authors.initials: AB
authors.lastname: Berlinski
authors.forename: Bruce K
authors.initials: BK
authors.lastname: Rubin
mesh_terms: D000280:Administration, Inhalation; D000336:Aerosols / Q000627:therapeutic use; D001993:Bronchodilator Agents / Q000627:therapeutic use; D002675:Child, Preschool; D004867:Equipment Design; D005145:Face; D005260:Female; D006801:Humans; D036503:Inhalation Spacers; D008297:Male; D008397:Masks / Q000592:standards; D036501:Metered Dose Inhalers
chemical_list: D000336:Aerosols; D001993:Bronchodilator Agents