© 2003 BMJ Publishing Group & Royal College of Paediatrics and Child Health
SHORT REPORT
Safety of inhaled corticosteroids delivered by plastic and metal spacers
1 IPROS Network of the Israel Ambulatory Pediatric Association and Schneider Children’s Medical Centre of Israel
2 McMaster University, Health Sciences, Hamilton, Ontario, Canada
Correspondence to:
Correspondence to:
Dr I Amirav, Hanarkis 41, Rosh Pina 12000, Israel;
amirav{at}012.net.il
Background: Because of its non-electrostatic properties the metal Nebuchamber (NC) valved holding chamber (VHC) delivers a greater mass of aerosol to the mouth than the polypropylene Aerochamber (AC) VHC. Delivery of more aerosol to the lungs may also increase systemic absorption of inhaled corticosteroids (ICS) and hypothalamo-pituitary-adrenal (HPA) suppression.
Methods: Thirty children (mean 4.3 (SD 0.3) years) received 200 µg budesonide twice daily by NC or AC, both with the mask provided, in a randomised, two month crossover trial. Twenty four hour urinary free cortisol (UFC) was determined as a measure of HPA suppression.
Results: UFC decreased from 42.3 (7.8) nmol UFC/nmol creatinine control to 26.2 (2.4) (p = 0.06 v control) after AC, and to 24.5 (2.5) (p = 0.04 v control) after NC (p = 0.4 AC v NC).
Conclusions: Despite a greater total dose delivered to the mouth, NC is not associated with greater HPA suppression when using 400 µg/day budesonide under real life conditions in young children.
Keywords: aerosol therapy; inhaled steroids; preschool; spacers; valved holding chambers
Abbreviations: AC, Aerochamber; HPA, hypothalamo-pituitary-adrenal; ICS, inhaled corticosteroids; MDI, metered dose inhaler; NC, Nebuchamber; UFC, urinary free cortisol; VHC, valved holding chamber
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