Inhalation Chambers in Neonatology: Benefit of a Device without Dead Space and Facemask Holding Duration for Optimal Corticosteroid Inhalation

Background: For most of inhalation chambers, the volume to breath in before getting the medication (dead volume), which includes the facemask and the mouthpiece volumes, exceeds breathing capacity of neonates. Moreover, maintaining an inhalation mask is not well tolerated by neonates and can lead to crying. The inability of babies to open the inspiratory valve and their crying have the effect of limiting or even preventing any pulmonary delivery of the drug.

Objective: This in vitro study aims, first, to show the benefit of using an inhalation device without inspiratory valve for neonates. Secondly, the effect of the facemask holding duration is analysed to minimize that time while ensuring an optimal drug inhalation.

Methods: Measurements comparing uncoordinated use of an inhalation chamber with and without inspiratory valve were performed using tidal breathing pattern of a neonate, issued by a breathing simulator (Copley Scientific). Inhalation chambers with facemask (NeonatHal® prototype, OptimHal-ProtecSom) were applied to an infant face model (Copley Scientific). Five pMDI doses (Beclometasone, 100µg/dose) were administered with 1-minute interval and respiration was maintained during 2 (3 seconds) to 40 (1 minute) breathing cycles after each pMDI dose administration. Inhaled drug was collected on a filter positioned between the face model and the breathing simulator. Drug quantifications were performed using UV spectrophotometry.

Conclusion: This study ascertains our previous results by showing that an inhalation chamber, without inspiratory valve, is beneficial for patients with low tidal volume. The assessment of the minimal duration of facemask application to reach an optimal drug deposition is particularly useful to minimize the occurrence of crying. Further experiments will be performed to extend the study to older babies.