Article Text

Download PDFPDF

Safety of inhaled corticosteroids delivered by plastic and metal spacers
  1. I Amirav1,
  2. Y Mansour1,
  3. T Tiosano1,
  4. S Chamny1,
  5. S Chirurg1,
  6. S Oren1,
  7. Z Grossman1,
  8. L Kahana1,
  9. E Kahan1,
  10. M T Newhouse2,
  11. For The Ipros Network
  1. 1IPROS Network of the Israel Ambulatory Pediatric Association and Schneider Children’s Medical Centre of Israel
  2. 2McMaster University, Health Sciences, Hamilton, Ontario, Canada
  1. Correspondence to:
    Dr I Amirav, Hanarkis 41, Rosh Pina 12000, Israel;


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.

  • aerosol therapy
  • inhaled steroids
  • preschool
  • spacers
  • valved holding chambers
  • AC, Aerochamber
  • HPA, hypothalamo-pituitary-adrenal
  • ICS, inhaled corticosteroids
  • MDI, metered dose inhaler
  • NC, Nebuchamber
  • UFC, urinary free cortisol
  • VHC, valved holding chamber

Statistics from


  • I Amirav is also affliated to Sieff Hospital, Safed, Israel

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.