The effect of body posture during medication inhalation on exercise induced bronchoconstriction in asthmatic children.
BACKGROUND
Inhaling medication in a standard body posture leads to impaction of particles in the sharp angle of the upper airway. Stretching the upper airway by extending the neck in a forward leaning body posture may improve pulmonary deposition. A single dose of inhaled corticosteroids (ICS) offers acute, but moderate protection against exercise induced bronchoconstriction (EIB). This study investigated whether inhaling a single dose of ICS in a forward leaning posture improves this protection against EIB.


METHODS
32 Asthmatic children, 5-16 years, with EIB (Median fall in FEV1 or FEV0.5 30.9%) performed two exercise challenge tests (ECT's) with spirometry in a single blinded cross-over trial design. Children inhaled a single dose of 200 μg beclomethasone dipropionate (BDP) 4 h before the ECT, once in the standard posture and once with the neck extended in a forward leaning posture. Spirometry was also performed before the inhalation of the single dose of BDP.


RESULTS
Inhalation of BDP in both body postures provided similar protection against EIB (fall in FEV1 or FEV0.1 in standard posture 16.7%; in forward leaning posture 15.1%, p = 0.83). Inhaling ICS in a forward leaning posture significantly delayed EIB compared to inhaling in the standard posture (respectively 2.5 min ± 1.0 min vs. 1.6 min ± 0.8 min; difference 0.9 min (95CI 0.25; 1.44 min); p = 0.01).


CONCLUSIONS
Inhalation of a single dose BDP in both the forward leaning posture and the standard posture provided effective and similar protection against EIB in asthmatic children, but the forward leaning posture resulted in a delay of EIB.
NTR3432 (www.trialregister.nl).
Department of Pediatrics, Medisch Spectrum Twente, P.O. Box 50 000, 7500 KA, Enschede, The Netherlands. Electronic address: reinavisser85@gmail.com.
Reina
R
Visser
Department of Emergency, Röpcke-Zweers Hospital, Hardenberg, The Netherlands.
Mariet
M
Wind
Department of Psychiatry, Ziekenhuisgroep Twente, Almelo, The Netherlands.
Beike J
BJ
de Graaf
Department of Pulmonary Function, Medisch Spectrum Twente, Enschede, The Netherlands.
Frans H C
FH
de Jongh
Medical School Twente, Medisch Spectrum Twente, Enschede, The Netherlands; Department of Research Methodology, Measurement and Data Analysis, University of Twente, Enschede, The Netherlands.
Job
J
van der Palen
Department of Pediatrics, Medisch Spectrum Twente, P.O. Box 50 000, 7500 KA, Enschede, The Netherlands.
Bernard J
BJ
Thio
D000280:Administration, Inhalation; D000293:Adolescent; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage*; D001249:Asthma / Q000188:drug therapy* / Q000503:physiopathology; D001250:Asthma, Exercise-Induced / Q000188:drug therapy* / Q000503:physiopathology / Q000517:prevention & control; D001507:Beclomethasone / Q000008:administration & dosage*; D016084:Bronchoconstriction / Q000187:drug effects*; D002648:Child; D002675:Child, Preschool; D018592:Cross-Over Studies; D005080:Exercise Test / Q000379:methods; D005260:Female; D005541:Forced Expiratory Volume / Q000187:drug effects; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D011187:Posture / Q000502:physiology; D012129:Respiratory Function Tests / Q000379:methods; D013147:Spirometry / Q000379:methods
D018927:Anti-Asthmatic Agents; D001507:Beclomethasone
Asthma; Body position; Inhalation therapy; Pediatrics; Pulmonary deposition