Reversibility of pulmonary function after inhaling salbutamol in different doses and body postures in asthmatic children.
BACKGROUND
Pulmonary medication is often delivered in the form of medical aerosols designed for inhalation. Recently, breath actuated inhalers (BAI's) gained popularity as they can be used without spacers. A major drawback of BAI's is the impaction in the upper airway. Stretching the upper airway by a forward leaning body posture with the neck extended ("sniffing position") during inhalation may reduce upper airway impaction and improve pulmonary deposition. Aim of this study was to investigate the reversibility of lung function with different doses salbutamol inhaled with a BAI in the forward leaning posture compared to the standard posture in asthmatic children.


METHODS
22 clinically stable asthmatic children, 5-14 years old, performed four reversibility measurements. Children inhaled 200 μg or 400 μg salbutamol with a BAI in the standard or in the forward leaning posture with the neck extended in a randomized single-blinded cross-over design.


RESULTS
Reversibility of lung function after inhaling salbutamol in the forward leaning posture was not significantly different compared to inhalation in the standard posture. Mean FEV1 reversibility was significantly greater after inhaling 400 μg salbutamol compared to 200 μg salbutamol in the standard posture (9.4% ± 9.5% versus 4.5% ± 7.5%, difference 4.9% (95CI 0.9; 9.0%); p = 0.021).


CONCLUSIONS
In clinically stable asthmatic children, inhalation of salbutamol with a BAI in a forward leaning posture does not increase reversibility of lung function. Inhalation of 400 μg compared to 200 μg salbutamol with a BAI does improve reversibility.
Department of Pediatrics, Medisch Spectrum Twente, P.O. Box 50 000, 7500 KA Enschede, The Netherlands. Electronic address: reinavisser85@gmail.com.
R
R
Visser
Department of Pediatrics, Medisch Spectrum Twente, P.O. Box 50 000, 7500 KA Enschede, The Netherlands; University Medical Centre Groningen, The Netherlands.
S
S
Kelderman
Department of Pulmonary Function, Medisch Spectrum Twente, Enschede, The Netherlands.
F 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.
J
J
van der Palen
Department of Pediatrics, Medisch Spectrum Twente, P.O. Box 50 000, 7500 KA Enschede, The Netherlands.
B J
BJ
Thio
D000280:Administration, Inhalation; D000336:Aerosols / Q000008:administration & dosage; D000420:Albuterol / Q000008:administration & dosage* / Q000009:adverse effects; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001249:Asthma / Q000188:drug therapy* / Q000503:physiopathology; D002648:Child; D018592:Cross-Over Studies; D005260:Female; D005541:Forced Expiratory Volume / Q000187:drug effects; D006801:Humans; D008297:Male; D056888:Patient Positioning / Q000379:methods*; D011187:Posture / Q000502:physiology; D011446:Prospective Studies; D012129:Respiratory Function Tests; D016037:Single-Blind Method; D013147:Spirometry / Q000379:methods; D016896:Treatment Outcome
D000336:Aerosols; D018927:Anti-Asthmatic Agents; D000420:Albuterol
Asthma; Body posture; Children; Inhalation; Medication deposition; Pulmonary function