Clinical Comparison of Gentle-Haler Actuator and Aerochamber Spacer for Metered Dose Inhaler (MDI) Use by Asthmatics

Abstract

BACKGROUND: Spacing devices such as the Aerochamber have been shown to improve delivery of medication from MDIs in patients who could not use proper technique with an MDI alone, but the Aerochamber may be inconvenient to carry & use because of its bulkiness. We therefore compared clinical responses of asth-matics using a new, smaller MDI actuator (Gentle-Haler) with no spacer to their responses using a standard MDI actuator & spacer (Aerochamber). METHODS: We treated 30 asthmatic patients in 2 sessions with the beta-agonist albuterol using the above-mentioned devices. Both devices were utilized in each treatment session, with one delivering albuterol & the other generating a placebo. During the second session on a different day, the albuterol & placebo were reversed with respect to the two devices. On each study day, physiologic measurements of FEV1, FVC, FEF25-75, blood pressure, & pulse were obtained at pretreatment (baseline) & after treatment at 15 & 30 minutes & 1, 2, 3, 4, 5, & 6 hours. Analysis of variance & Stu- dent's t test were used to compare the ratio of physiologic responses to albuterol delivered with the two devices. RESULTS: Both devices were equally effective in eliciting desirable increases in FEV1, FEF25-75, & FVC. No statistically significant differences (5% significance level) in effectiveness of the albuterol were associated with the use of either device. A very small (<7%) but statistically significant re- duction in diastolic blood pressure (3 of 8 time points) & systolic pressure (1 of 8 time points) was associated with the use of the Gentle-Haler. No statistically sig-nificant differences in pulse rate were associated with use of the two devices. Be-cause the Gentle-Haler device is small & compact, its use was preferred by 22 of the 30 patients surveyed.