title: Determination of parameters related to nasal inspiratory pressures in children utilizing valved-holding chambers (valved spacers).
abstract: OBJECTIVE
  The administration of medication by the nasal route using valved spacers, may be an alternative for the concomitant treatment of allergic rhinitis and asthma. The aim of this study was to determine if children are capable, in using a spacer and face mask, of opening the inspiratory valve using only nasal inhalation.
  
  
  METHODS
  Prospective cross-sectional. The study included 85 children aged 4-9 years. Four types of valved spacers connected to a digital vacuum manometer were evaluated. The patients were prompted to inhale through their nose and the pressure reached in the first curve, maximal peak and time between the start of the inspiratory action and the first effective inspiration (opening of the valve) were determined. The results were compared with factors such as age, weight, BMI, gender, and presence of rhinitis or asthma.
  
  
  RESULTS
  In two of the spacers, the valve opened in 98.8% of the tests with nasal inspiration only. The spacer ACE holding chamber showed initial and maximal inspiratory pressures that were significantly greater than with the others (p<0.001). No correlation was observed between the parameters examined for each spacer and the patient variables considered.
  
  
  CONCLUSIONS
  The results suggest that children 4-9 years old are able to open the spacer valve with only nasal inspiration. The spacer ACE holding chamber was shown to be significantly more effective than the others tested. Studies that demonstrate that air inspired nasally reaches the lungs effectively are necessary so that this airway can be utilized for the administration of therapeutic agents.
authors.affiliation: Department of Otorhinolaryngology, Santo Antonio Children's Hospital, Complexo Hospitalar Santa Casa de Porto Alegre, Brazil. ritak@cpovo.net
authors.forename: Rita
authors.initials: R
authors.lastname: Krumenauer
authors.forename: Sérgio Luis
authors.initials: SL
authors.lastname: Amantéa
authors.forename: José Faibes
authors.initials: JF
authors.lastname: Lubianca Neto
authors.forename: Ana Paula
authors.initials: AP
authors.lastname: Brasil
authors.forename: Rosane
authors.initials: R
authors.lastname: Reginato
authors.forename: Alexandre Vontobel
authors.initials: AV
authors.lastname: Padoin
mesh_terms: D000280:Administration, Inhalation; D001249:Asthma / Q000188:drug therapy; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D001239:Inhalation; D008297:Male; D036501:Metered Dose Inhalers; D011312:Pressure; D025363:Rhinomanometry