Systemic Exposures of Fluticasone Propionate and Salmeterol Following Inhalation via Metered Dose Inhaler with the Mini Spacer Compared with the Aerochamber Plus Spacer

Reviewed by: Denise Conti, Anthony Hickey

Address correspondence to: Rashmi Mehta, PhD, GlaxoSmithKline, Research Triangle Park, 3040 E Cornwallis Road, Durham 27709, North Carolina, E-mail: [email protected]

Introduction

Asthma and chronic obstructive pulmonary disease (COPD) are common, chronic respiratory diseases that afflict millions of people worldwide and are responsible for significant morbidity and mortality.^(1-5) They are also associated with substantial healthcare costs, particularly when the disease is not well controlled.^(6-8) Lack of adherence to medication is one of the factors associated with poor disease control, resulting in both worse clinical and economic outcomes,^(9-11) and is often associated with improper use of prescribed therapy.^(11,12)

Inhalation is the preferred route of administration of medicines in the treatment of asthma and COPD due to the advantages of direct delivery to the lungs, rapid onset of action, and minimal systemic side effects.^(1,2,13) The available inhaled drug delivery systems include metered dose inhalers (MDI), dry powder inhalers, and nebulizers,^(1,2) each of which has different delivery characteristics.⁽¹³⁾ Many factors influence the choice of an inhaled delivery system, including ease of use, availability of the drug with a particular device, efficiency and reliability of drug delivery, cost, and patient preference.^(1,2,13)

MDIs are widely used for the delivery of asthma and COPD drugs due to their compatibility with most drugs, effectiveness, and relatively low costs.⁽¹⁴⁾ This last factor may be very important in developing countries where access to affordable medications is a primary concern.^(15,16) However, one of the limitations of MDIs is the requirement for coordination of actuation and inhalation; a good inhaler technique is necessary to successfully deliver the required dose of drug to the lungs.^(1,2)

Problems with coordination can be overcome by using an MDI with a spacer device.^(1,2) A spacer is a generic term for a range of add-on devices that provide an extension to an MDI and consist of a...