Drug–device interaction for systemic effects of fluticasone in patients with asthma

The recent review article by Carr and Szefler on the systemic safety of inhaled corticosteroids concluded with the erroneous assertion, "Another option to reduce systemic exposure is to use spacers or valved holding chambers with pressurized MDI's."1 For drugs such as fluticasone, the systemic bioactivity is purely determined by lung bioavailability because of its almost complete first-pass hepatic inactivation for the swallowed dose. Hence, increasing lung deposition by using fluticasone through a pressurized metered-dose inhaler in conjunction with a spacer will greatly increase systemic bioactivity, as assessed by measuring cortisol suppression.

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