Reversibility after inhaling salbutamol in different body postures in asthmatic children: a pilot study.
BACKGROUND
Pulmonary medication is mostly delivered in the form of medical aerosols to minimize systemic side effects. A major drawback of inhaled medication is that the majority of inhaled particles impacts in the oropharynx at the sharp bend of the airway. Stretching the airway by a forward leaning body posture with the neck extended ("sniffing position") may improve pulmonary deposition and clinical effects.


METHODS
41 asthmatic children who were planned for standard reversibility testing at the pulmonary function lab, alternately inhaled 200 μgr salbutamol with an Autohaler(®) in the standard or in the forward leaning body posture. Forced Expiratory Volume in 1 s (FEV1), Forced Vital Capacity (FVC), Peak Expiratory Flow (PEF), Mean Expiratory Flow at 25% of vital capacity (MEF25) and Mean Expiratory Flow at 75% of vital capacity (MEF75) were analysed.


RESULTS
The children in the forward leaning body posture group showed a significantly higher mean FEV1 reversibility than the control group after inhalation of 200 μgr salbutamol (10.2% versus 4.1%, p = 0.019). Additionally, mean MEF75 was significantly more reversible in the forward leaning body posture group versus the standard body posture group (32.2% resp. 8.9%, p = 0.013).


CONCLUSIONS
This pilot study showed a higher reversibility of FEV1 and MEF75 after inhaling salbutamol in a forward leaning body posture compared to the standard body posture in asthmatic children. This suggests that pulmonary effects of salbutamol can be improved by inhaling in a forward leaning body posture with the neck extended. This effect is possibly due to a higher pulmonary deposition of salbutamol and should be confirmed in a randomized controlled trial.
Department of Pediatrics, Medisch Spectrum Twente, P.O. Box 50 000, 7500 KA Enschede, The Netherlands. Electronic address: reinavisser85@gmail.com.
R
R
Visser
Medical School Twente, Medisch Spectrum Twente, P.O. Box 50 000, 7500 KA Enschede, The Netherlands; Department of Research Methodology, Measurement and Data Analysis, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands. Electronic address: j.vanderpalen@mst.nl.
J
J
van der Palen
Department of Pulmonary Function, Medisch Spectrum Twente, P.O. Box 50 000, 7500 KA Enschede, The Netherlands. Electronic address: f.dejongh@mst.nl.
F H C
FH
de Jongh
Department of Pediatrics, Medisch Spectrum Twente, P.O. Box 50 000, 7500 KA Enschede, The Netherlands. Electronic address: b.thio@mst.nl.
B J
BJ
Thio
D000280:Administration, Inhalation; D000293:Adolescent; D000420:Albuterol / Q000008:administration & dosage*; D001249:Asthma / Q000188:drug therapy / Q000503:physiopathology; D001993:Bronchodilator Agents / Q000008:administration & dosage; D002648:Child; D016903:Drug Monitoring; D005260:Female; D005541:Forced Expiratory Volume / Q000187:drug effects*; D006801:Humans; D001239:Inhalation / Q000502:physiology; D008297:Male; D056888:Patient Positioning / Q000379:methods*; D010865:Pilot Projects; D016896:Treatment Outcome
D001993:Bronchodilator Agents; D000420:Albuterol
Body posture; Inhalation; Pediatric asthma; Reversibility