Can Pulmicort Inhalers Be Used with AeroChamber?
Yes, Pulmicort (budesonide) metered-dose inhalers can and should be used with an AeroChamber or other valved holding chambers (VHCs) to optimize drug delivery and reduce oropharyngeal deposition.
Why Use a Valved Holding Chamber with Pulmicort
VHCs significantly improve the fine particle fraction delivered to the lungs (69-79% with VHC versus approximately 40% without) when using pressurized metered-dose inhalers containing inhaled corticosteroids like budesonide 1.
Spacers and VHCs reduce oropharyngeal deposition by 50-80%, which is particularly important for inhaled corticosteroids to minimize local side effects like oral thrush 1.
Mouth rinsing and spitting after use is effective in reducing systemic absorption, and this practice should be combined with VHC use for optimal safety 1.
AeroChamber Performance with Inhaled Corticosteroids
The AeroChamber Plus delivers equivalent fine particle doses (46.4 ± 3.4 mcg) compared to larger VHCs like the Volumatic (46.3 ± 2.7 mcg) when used with combination corticosteroid/bronchodilator MDIs 2.
Small-volume VHCs like the AeroChamber (149 mL) perform as well as large-volume devices (750 mL) in terms of lung deposition, while offering better portability and potentially improved compliance 2.
The AeroChamber Plus Flow-Vu with antistatic properties has been associated with lower asthma exacerbation rates (10-12% reduction) and reduced healthcare costs compared to non-antistatic VHCs 3.
Optimal Technique for Pulmicort with AeroChamber
Patients should perform slow, deep inhalation (30 L/min or 3-5 seconds) immediately after actuation, followed by a 10-second breath hold 1.
For children under 4 years old or patients unable to coordinate actuation, a VHC with mask may be necessary, though mouthpieces are preferred when feasible to reduce facial deposition 1.
Patients should actuate only once into the chamber and inhale immediately, as medication settles rapidly in the chamber 1.
Important Caveats
Pulmicort Respules (nebulizer suspension) are NOT used with AeroChambers—they require jet nebulizers with appropriate flow rates of 6-8 L/min 1, 4. The question specifically asks about "Pulmicort inhalers," which refers to the MDI formulation, not the nebulizer suspension.
Mouthpieces should be used preferentially over masks for nebulized steroids to prevent facial deposition and reduce the risk of perioral dermatitis 1.
The mouth must be rinsed after each use to prevent oral candidiasis, regardless of whether a VHC is used 1.
Clinical Context
Guidelines recommend pressurized metered-dose inhalers with valved holding chambers over nebulizers when possible, as they reduce infection transmission risk and provide more consistent dosing 1.
VHCs are particularly beneficial for patients who have difficulty with MDI coordination, including elderly patients and those with acute symptoms 1.