The effect of body posture during medication inhalation on exercise induced bronchoconstriction in asthmatic children. Issue 10 (October 2015)

• Record Type: Journal Article
• Authors: Visser, Reina; Wind, Mariet; de Graaf, Beike J.; de Jongh, Frans H.C.; van der Palen, Job; Thio, Bernard J.
• Is Part Of: Respiratory medicine. Volume 109:Issue 10(2015)
• Page Start: 1257
• Page End: 1261
• Publication Date: 2015-10
• Subjects: Asthma -- Pediatrics -- Body position -- Inhalation therapy -- Pulmonary deposition; ICS Inhalation corticosteroids -- EIB exercise induced bronchoconstriction -- FEV1 forced expiratory volume in 1sec -- FEV0.5 forced expiratory volume in 0.5sc -- ECT exercise challenge test -- BPD beclomethasone-dipropionate -- BAI breath actuated inhaler -- (C)-ACT (childhood) asthma control test; Chest -- Diseases -- Periodicals; Chest -- Diseases -- Great Britain -- Periodicals; Respiratory organs -- Diseases -- Periodicals; Respiratory Tract Diseases -- Periodicals; Appareil respiratoire -- Maladies -- Périodiques; Thorax -- Maladies -- Périodiques; Appareil respiratoire -- Maladies -- Traitement -- Périodiques; Electronic journals; 616.2
• DOI: 10.1016/j.rmed.2015.08.012
• Languages: English
• ISSNs: 0954-6111

Abstract

Abstract: Rationale: Inhaling medication in a standard body posture leads to impaction of particles in the sharp angle of the upper airway. Stretching the upper airway by extending the neck in a forward leaning body posture may improve pulmonary deposition. A single dose of inhaled corticosteroids (ICS) offers acute, but moderate protection against exercise induced bronchoconstriction (EIB). This study investigated whether inhaling a single dose of ICS in a forward leaning posture improves this protection against EIB. Methods: 32 Asthmatic children, 5–16 years, with EIB (Median fall in FEV1 or FEV0.5 30.9%) performed two exercise challenge tests (ECT's) with spirometry in a single blinded cross-over trial design. Children inhaled a single dose of 200 μg beclomethasone dipropionate (BDP) 4 h before the ECT, once in the standard posture and once with the neck extended in a forward leaning posture. Spirometry was also performed before the inhalation of the single dose of BDP. Results: Inhalation of BDP in both body postures provided similar protection against EIB (fall in FEV1 or FEV0.1 in standard posture 16.7%; in forward leaning posture 15.1%, p = 0.83). Inhaling ICS in a forward leaning posture significantly delayed EIB compared to inhaling in the standard posture (respectively 2.5 min ± 1.0 min vs. 1.6 min ± 0.8 min; difference 0.9 min (95CI 0.25; 1.44 min); p = 0.01). Conclusion: Inhalation of a single dose BDP in both the forward leaning posture and the standard posture provided effective and similar protection against EIB in asthmatic children, but the forward leaning posture resulted in a delay of EIB. Register: NTR3432 (www.trialregister.nl ). Graphical abstract: Highlights: A drawback of inhalers is the impaction of medication in the upper airway. We examined the effect on EIB of stretching the upper airway during BDP inhalation. Stretching the upper airway resulted in postponed EIB. Stretching the upper airway did not result in a greater protection against EIB. This suggests body posture can influence effects of inhaled medication.