Reversibility after inhaling salbutamol in different body postures in asthmatic children: A pilot study - 25/02/15

Doi : 10.1016/j.rmed.2015.02.007

R. Visser ^a,^⁎ , J. van der Palen ^b,^c , F.H.C. de Jongh ^d , B.J. Thio ^a
^a Department of Pediatrics, Medisch Spectrum Twente, P.O. Box 50 000, 7500 KA Enschede, The Netherlands
^b Medical School Twente, Medisch Spectrum Twente, P.O. Box 50 000, 7500 KA Enschede, The Netherlands
^c Department of Research Methodology, Measurement and Data Analysis, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands
^d Department of Pulmonary Function, Medisch Spectrum Twente, P.O. Box 50 000, 7500 KA Enschede, The Netherlands

^∗Corresponding author. Tel.: +31 534872310.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Wednesday 25 February 2015

Summary

Rationale

Pulmonary medication is mostly delivered in the form of medical aerosols to minimize systemic side effects. A major drawback of inhaled medication is that the majority of inhaled particles impacts in the oropharynx at the sharp bend of the airway. Stretching the airway by a forward leaning body posture with the neck extended (“sniffing position”) may improve pulmonary deposition and clinical effects.

Methods

41 asthmatic children who were planned for standard reversibility testing at the pulmonary function lab, alternately inhaled 200 μgr salbutamol with an Autohaler^® in the standard or in the forward leaning body posture. Forced Expiratory Volume in 1 s (FEV₁), Forced Vital Capacity (FVC), Peak Expiratory Flow (PEF), Mean Expiratory Flow at 25% of vital capacity (MEF₂₅) and Mean Expiratory Flow at 75% of vital capacity (MEF₇₅) were analysed.

Results

The children in the forward leaning body posture group showed a significantly higher mean FEV₁ reversibility than the control group after inhalation of 200 μgr salbutamol (10.2% versus 4.1%, p = 0.019). Additionally, mean MEF₇₅ was significantly more reversible in the forward leaning body posture group versus the standard body posture group (32.2% resp. 8.9%, p = 0.013).

Conclusion

This pilot study showed a higher reversibility of FEV₁ and MEF₇₅ after inhaling salbutamol in a forward leaning body posture compared to the standard body posture in asthmatic children. This suggests that pulmonary effects of salbutamol can be improved by inhaling in a forward leaning body posture with the neck extended. This effect is possibly due to a higher pulmonary deposition of salbutamol and should be confirmed in a randomized controlled trial.

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Keywords : Pediatric asthma, Reversibility, Body posture, Inhalation

Abbreviations : BAI