{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T17:40:20Z","timestamp":1776274820837,"version":"3.50.1"},"reference-count":49,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T00:00:00Z","timestamp":1776211200000},"content-version":"unspecified","delay-in-days":14,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100008309","name":"Hengityssairauksien Tutkimuss\u00e4\u00e4ti\u00f6","doi-asserted-by":"publisher","award":["no grant number"],"award-info":[{"award-number":["no grant number"]}],"id":[{"id":"10.13039\/501100008309","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008723","name":"Suomen L\u00e4\u00e4ketieteen S\u00e4\u00e4ti\u00f6","doi-asserted-by":"publisher","award":["no grant number"],"award-info":[{"award-number":["no grant number"]}],"id":[{"id":"10.13039\/100008723","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010125","name":"Jalmari ja Rauha Ahokkaan S\u00e4\u00e4ti\u00f6","doi-asserted-by":"publisher","award":["no grant number"],"award-info":[{"award-number":["no grant number"]}],"id":[{"id":"10.13039\/100010125","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100006706","name":"Tampereen Tuberkuloosis\u00e4\u00e4ti\u00f6","doi-asserted-by":"publisher","award":["no grant number"],"award-info":[{"award-number":["no grant number"]}],"id":[{"id":"10.13039\/501100006706","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Resp Res"],"accepted":{"date-parts":[[2026,3,25]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Valved holding chambers (VHCs) are not interchangeable. Because VHC design and formulation type influence aerosol behaviour, each VHC\u2013drug combination should be evaluated to inform clinical use and device selection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To compare the aerodynamic particle size distribution (APSD) of two inhaled corticosteroids delivered from pressurised metered dose inhalers with and without commonly used VHCs under realistic, adult-representative breathing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We assessed fluticasone propionate (FP, suspension) and ciclesonide (CIC, solution) using no VHC and three VHCs (AeroChamber, EasyChamber and OptiChamber Diamond). A Next Generation Impactor was connected to an anatomically representative adult throat model and a breathing simulator generating an adult-type inhalation profile.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Without a VHC, throat deposition was high. With any VHC, throat deposition fell to only a few per cent of the label claim for both FP and CIC. The 1\u20135\u2009\u00b5m respirable fraction was approximately one-third of the label claim for both drugs, irrespective of VHC use, while CIC generated a larger submicron fraction than FP. Small statistically significant differences between VHCs were observed, but absolute differences in APSD and throat deposition were modest.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In adult-representative conditions, VHCs substantially reduce oropharyngeal deposition but do not influence fine-particle delivery. Differences between the tested VHCs were minor and unlikely to be clinically meaningful, whereas FP and CIC showed distinct APSD profiles consistent with formulation type. These findings support performance-based, drug-specific evaluation of VHCs and underscore the value of systematic in vitro testing to guide evidence-based spacer\u2013drug selection and to reduce throat deposition in clinical practice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjresp-2025-003963","type":"journal-article","created":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T16:40:33Z","timestamp":1776271233000},"page":"e003963","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["In vitro characterisation of fluticasone propionate and ciclesonide delivered with and without valved holding chambers using cascade impaction and an adult simulated breathing profile"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-0215-0805","authenticated-orcid":false,"given":"Leon L","family":"Csonka","sequence":"first","affiliation":[{"name":"Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lauri","family":"Lehtim\u00e4ki","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland"},{"name":"Allergy Centre, Tampere University Hospital, Tampere, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0819-7875","authenticated-orcid":false,"given":"P\u00e9ter","family":"Csonka","sequence":"additional","affiliation":[{"name":"Tampere Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,4,15]]},"reference":[{"key":"2026041509401851000_13.1.e003963.1","unstructured":"Global Initiative for Asthma . 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