title: Respirable dose delivery of fluticasone propionate from a small valved holding chamber, a compact breath actuated integrated vortex device and a metered dose inhaler.
abstract: OBJECTIVE
  To compare the respirable dose delivery of the hydrofluroalkane fluticasone propionate (HFA-FP) via an optimally prepared Aerochamber Plus spacer (AP), via a Synchro-Breathe (SB) device, and pMDI Evohaler (EH).
  
  
  METHODS
  Seventeen mild to moderate asthmatics completed the study using a randomized, double-blind, double-dummy, three way crossover design. Single doses of placebo or HFA-FP 2.0 mg were administered via the EH, AP, and SB devices. The overnight urinary cortisol : creatinine ratio (OUCC) was measured at baseline and after each dose.
  
  
  RESULTS
  Significant suppression of OUCC occurred from baseline with AP and SB but not EH devices (geometric mean fold suppression, 95% CI): AP: 3.18 (2.29, 4.36), P < 0.001; SB: 1.79 (1.31, 2.40), P = 0.001; EH: 1.12 (0.69, 1.44), p = 0.37 (equating to 68%, 45% and 9% falls, respectively). Significant differences in OUCC between devices were as follows: (geometric mean fold difference, 95% CI): AP vs. EH. 2.83 (2.09, 3.82), P < 0.001; AP vs. SB: 1.78 fold (1.21, 2.60), P = 0.003; SB vs. EH: 1.59 (1.09, 2.31), P = 0.013 (equating to 65%, 44% and 37% differences, respectively).
  
  
  CONCLUSIONS
  The use of an optimally prepared AP spacer and breath actuated SB device, when compared with pMDI, significantly increased the respirable dose of HFA-FP.
authors.affiliation: Asthma and Allergy Research Group, Department of Medicine and Therapeutics, Ninewells Hospital and Medical School, University of Dundee, Dundee, Scotland, UK. a.nair@dundee.ac.uk
authors.forename: Arun
authors.initials: A
authors.lastname: Nair
authors.forename: Daniel
authors.initials: D
authors.lastname: Menzies
authors.forename: Martyn
authors.initials: M
authors.lastname: Barnes
authors.forename: Patricia
authors.initials: P
authors.lastname: Burns
authors.forename: Lesley
authors.initials: L
authors.lastname: McFarlane
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Lipworth
mesh_terms: D000328:Adult; D000730:Androstadienes / Q000008:administration & dosage* / Q000494:pharmacology; D001249:Asthma / Q000188:drug therapy*; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D003401:Creatine / Q000652:urine; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005260:Female; D000068298:Fluticasone; D006801:Humans; D006854:Hydrocortisone / Q000652:urine; D036503:Inhalation Spacers / Q000592:standards; D008297:Male; D036501:Metered Dose Inhalers / Q000592:standards*; D008875:Middle Aged
chemical_list: D000730:Androstadienes; D001993:Bronchodilator Agents; D000068298:Fluticasone; D003401:Creatine; D006854:Hydrocortisone