PT  - JOURNAL ARTICLE
AU  - I Amirav
AU  - Y Mansour
AU  - T Tiosano
AU  - S Chamny
AU  - S Chirurg
AU  - S Oren
AU  - Z Grossman
AU  - L Kahana
AU  - E Kahan
AU  - M T Newhouse
TI  - Safety of inhaled corticosteroids delivered by plastic and metal spacers
AID  - 10.1136/adc.88.6.527
DP  - 2003 Jun 01
TA  - Archives of Disease in Childhood
PG  - 527--528
VI  - 88
IP  - 6
4099  - http://adc.bmj.com/content/88/6/527.short
4100  - http://adc.bmj.com/content/88/6/527.full
SO  - Arch Dis Child2003 Jun 01; 88
AB  - 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.