In vivo gamma scintigraphy comparison of inhaled corticosteroid monotherapy delivered by pressurised metered dose inhaler with and without a spacer in adolescents with asthma

Asthma control during adolescence is suboptimal, and partly attributed to poor inhaler technique. Spacers somewhat overcome these issues, but may be difficult to implement in practice, particularly in adolescents. Our pilot study of 14 adolescent participants demonstrated equivalent lung deposition with or without a spacer for both coarse and extrafine preventer aerosols, however, effect on oropharyngeal deposition was greater with the coarse formulation (30% reduction in oropharyngeal dose with spacer use, versus 10% with the extrafine formulation). Following verification from further studies, and with good, consistent, inhalation technique, spacers may not be required in adolescent populations with extrafine preventer formulations.