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GLO:FS1/01oct21:pai13544-fig-0001.jpg PHOTO (COLOR): 1 Vigorously shaking the ampoule before use increases dispersion of budesonide particles and maximizes available treatment dose. According to the manufacturer's recommendation, ampoules should be gently shaken before use.7 Although there is no reference to time, provided that patients or healthcare professionals have shaken the ampoules gently for 30 s and emptied the contents into the therapeutic container, the maximum loaded dose should represent approximately 81% of the label claim dose, according to our results. Asthma, corticosteroids, delivered dose, Intranasal Administration, nasal irrigation, nebulizers, suspension aerosols Keywords: asthma; corticosteroids; delivered dose; Intranasal Administration; nasal irrigation; nebulizers; suspension aerosols EN asthma corticosteroids delivered dose Intranasal Administration nasal irrigation nebulizers suspension aerosols 1566 1568 3 10/04/21 20211001 NES 211001 AUTHOR CONTRIBUTION B Taciano Rocha: b Conceptualization (equal); Data curation (equal); Formal analysis (equal); Methodology (equal); Project administration (equal); Visualization (equal); Writing-original draft (equal); Writing-review & editing (equal). [Extracted from the article]

The article focuses on the development and use of aerosol drug delivery devices for treating respiratory disorders. It states that there is an increase use of aerosol drugs because of the advantage of delivering the doses to affected sites. It mentions that the technical innovations on these drug delivery devices results into efficient delivery of drug and features dose tracking, portability, and combination therapies. It adds that the performance of inhalers, spacer, and nebulisers improved.

Background: The proliferation of inhaler devices has resulted in a confusing number of choices for clinicians who are selecting a delivery device for aerosol therapy. There are advantages and disadvantages associated with each device category. Evidence-based guidelines for the selection of the appropriate aerosol delivery device in specific clinical settings are needed. Aim: (1) To compare the efficacy and adverse effects of treatment using nebulizers vs pressurized metered-dose inhalers (MDIs) with or without a spacer/holding chamber vs dry powder inhalers (DPIs) as delivery systems for β-agonists, anticholinergic agents, and corticosteroids for several commonly encountered clinical settings and patient populations, and (2) to provide recommendations to clinicians to aid them in selecting a particular aerosol delivery device for their patients. Methods: A systematic review of pertinent randomized, controlled clinical trials (RCTs) was undertaken using MEDLINE, EmBase, and the Cochrane Library databases. A broad search strategy was chosen, combining terms related to aerosol devices or drugs with the diseases of interest in various patient groups and clinical settings. Only RCTs in which the same drug was administered with different devices were included. RCTs (394 trials) assessing inhaled corticosteroid, β2-agonist, and anticholinergic agents delivered by an MDI, an MDI with a spacer/ holding chamber, a nebulizer, or a DPI were identified for the years 1982 to 2001. A total of 254 outcomes were tabulated. Of the 131 studies that met the eligibility criteria, only 59 (primarily those that tested β2-agonists) proved to have useable data. Results: None of the pooled metaanalyses showed a significant difference between devices in any efficacy outcome in any patient group for each of the clinical settings that was investigated. The adverse effects that were reported were minimal and were related to the increased drug dose that was delivered. Each of the delivery devices provided similar outcomes in patients using the correct technique for inhalation. Conclusions: Devices used for the delivery of bronchodilators and steroids can be equally efficacious. When selecting an aerosol delivery device for patients with asthma and COPD, the following should be considered: device/drug availability; clinical setting; patient age and the ability to use the selected device correctly; device use with multiple medications; cost and reimbursement; drug administration time; convenience in both outpatient and inpatient settings; and physician and patient preference. [ABSTRACT FROM AUTHOR]