An apparatus to deliver mannitol powder for bronchial provocation in children under six years old

Tang, Patricia, Leung, Sharon S.Y., Hor, Eleanor, Ruzycki, Conor A., Carrigy, Nicholas B., Finlay, Warren H., Brannan, John D., Devadason, Sunalene, Anderson, Sandra D., Sly, Peter D., Samnick, Kevin and Chan, Hak-Kim (2015) An apparatus to deliver mannitol powder for bronchial provocation in children under six years old. Journal of Aerosol Medicine and Pulmonary Drug Delivery, 28 6: 452-461. doi:10.1089/jamp.2015.1208

Author Tang, Patricia
Leung, Sharon S.Y.
Hor, Eleanor
Ruzycki, Conor A.
Carrigy, Nicholas B.
Finlay, Warren H.
Brannan, John D.
Devadason, Sunalene
Anderson, Sandra D.
Sly, Peter D.
Samnick, Kevin
Chan, Hak-Kim
Title An apparatus to deliver mannitol powder for bronchial provocation in children under six years old
Journal name Journal of Aerosol Medicine and Pulmonary Drug Delivery   Check publisher's open access policy
ISSN 1941-2703
Publication date 2015-12-01
Year available 2015
Sub-type Article (original research)
DOI 10.1089/jamp.2015.1208
Open Access Status Not yet assessed
Volume 28
Issue 6
Start page 452
End page 461
Total pages 10
Place of publication New Rochelle, NY, United States
Publisher Mary Ann Liebert
Language eng
Formatted abstract
Background: Currently bronchial provocation testing (BPT) using mannitol powder cannot be performed in children under 6 years. A primary reason is it is challenging for children at this age to generate a consistent inspiratory effort to inhale mannitol efficiently from a dry powder inhaler. A prototype system, which does not require any inhalation training from the pediatric subject, is reported here. It uses an external source of compressed air to disperse mannitol powder into a commercial holding chamber. Then the subject uses tidal breathing to inhale the aerosol.

Method: The setup consists of a commercially available powder disperser and Volumatic™ holding chamber. Taguchi experimental design was used to identify the effect of dispersion parameters (flow rate of compressed air, time compressed air is applied, mass of powder, and the time between dispersion and inhalation) on the fine particle dose (FPD). The prototype was tested in vitro using a USP throat connected to a next generation impactor. The aerosols from the holding chamber were drawn at 10 L/min. A scaling factor for estimating the provoking dose to induce a 15% reduction in forced expiratory volume in 1 second (FEV1) (PD15) was calculated using anatomical dimensions of the human respiratory tract at various ages combined with known dosing values from the adult BPT.

Consistent and doubling FPDs were successfully generated based on the Taguchi experimental design. The FPD was reliable over a range of 0.8 (±0.09) mg to 14 (±0.94) mg. The calculated PD15 for children aged 1–6 years ranged from 7.1–30 mg. The FPDs generated from the proposed set up are lower than the calculated PD15 and therefore are not expected to cause sudden bronchoconstriction.

A prototype aerosol delivery system has been developed that is consistently able to deliver doubling doses suitable for bronchial provocation testing in young children.
Keyword Airway hyper-responsiveness
Bronchial provocation testing
Mannitol powder
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2016 Collection
Child Health Research Centre Publications
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