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Future options for aerosol delivery to children
1Department of Paediatrics, National University Hospital, Copenhagen, Denmark. Bisgaard@RH.DK
Insights
Optimizing aerosol drug delivery in children requires devices that deliver precise lung doses. New nonelectrostatic spacers and intelligent inhalers improve drug delivery and patient compliance.
Area of Science:
- Pediatric Respiratory Medicine
- Pharmacology and Pharmaceutical Science
- Biomedical Engineering
Background:
- Reliable aerosol delivery to the lungs is crucial for effective pediatric treatment, focusing on lung dose, clinical control, cost, and safety.
- Current drug prescription practices often overlook the device's role in determining the actual lung dose, necessitating a shift towards device-specific prescriptions.
- Understanding factors influencing airway drug delivery, such as nasal inhalation and dead space, is key to optimizing inhaled therapies.
Purpose of the Study:
- To highlight the importance of device selection in aerosol therapy for children.
- To discuss recent advancements in aerosol delivery devices aimed at improving lung dose and patient compliance.
- To advocate for device-specific drug approvals and the development of child-centric inhaler technologies.
Main Methods:
- Review of factors affecting aerosol deposition in the lungs, including device design and material properties.
- Analysis of new technologies like nonelectrostatic spacers, intelligent nebulizers, and automatic dry powder inhaler adapters.
- Evaluation of features designed to enhance usability and effectiveness in pediatric patients, such as face masks and reduced dead space.
Main Results:
- Nonelectrostatic materials in spacers significantly increase lung dose by preventing drug loss due to electrostatic attraction.
- Intelligent nebulizers adapt to a child's breathing pattern, optimizing nebulization during inhalation and reducing waste.
- New devices like the AirPac and tower-shaped spacers offer improved aerosol stability, prolonged residence time, and reduced nasal deposition, enhancing drug delivery in children.
Conclusions:
- Device selection is integral to aerosol drug prescription, requiring clear specifications in drug approval processes.
- Innovations in spacer technology, particularly the use of nonelectrostatic materials and child-friendly designs, are essential for improving lung dose and treatment adherence.
- Future developments should focus on intelligent, adaptive devices that cater to the specific needs and behaviors of pediatric patients to optimize inhaled aerosol therapy.
Abstract:
There is an increasing awareness of the importance of reliable aerosol delivery, with emphasis on the dose delivered to the lungs, optimal clinical control, cost-effectiveness, and safety in children. Dose prescription should relate to the expected lung dose rather than the factory-dispensed dose, as at present. The device determines the lung dose. Clearly, therefore, the device should be considered an integral part of the prescription. Drug approval processes should clearly specify the device, and discourage the use of other devices. This would rationalize the choice of devices. Important new insights into factors essential for drug delivery to the airways have been acquired in recent years. Nasal inhalation increases systemic bioavailability, reduces lung dose, and adds to its variability; hence, face masks to prevent nasal breathing have been developed. Similarly, dead space in the inspiratory line causes a proportional reduction in lung dose; hence, attention should be paid to reducing such dead space. Plastics in spacers cause a rapid loss of drug due to electrostatic attraction of the aerosol. The residence time of the aerosol, i.e., the time available for inhalation, is increased in nonelectrostatic spacers, allowing less compliant children enough time to obtain a full dose. Eliminating the electrostatic charge can change the lung dose by several times; hence, nonelectrostatic materials should be used in future spacer devices. Compliance is the biggest problem in drug delivery to children. The inhaler design process should be reversed, adapting technology to the child. Interactive microchip technology should provide intelligent devices that react to correct handling and breathing maneuvers. An intelligent nebulizer has been developed that adapts nebulization to the child's breathing pattern, nebulizing only during inhalation and avoiding loss of aerosol during exhalation. An automatic device (AirPac) has been developed that transforms a dry-powder inhaler, Turbuhaler, into a spacer. In addition to the general advantages of spacer treatment, this device offers the advantage of a drug aerosol delivered without use of propellants or additives. The mechanical actuation ensures highly repeatable drug delivery. Finally, a nonelectrostatic, tower-shaped spacer provides a stable aerosol, which remains airborne for a prolonged period. The spacer is equipped with a face mask that prevents nasal breathing. Such features should improve our ability to treat young children with inhaled drug aerosols.