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Antiasthmatic drug delivery in children
Elizabeth Biggart1, Andrew Bush
1Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, Sydney Street, London SW3 6NP, United Kingdom.
Insights
Inhaled asthma medications for children are common, but real-world effectiveness varies. Device choice significantly impacts medication delivery and should guide dosage reviews.
Area of Science:
- Pediatric Pulmonology
- Pharmacology
- Respiratory Medicine
Background:
- Asthma management in children involves various administration routes, with inhalation being most frequent.
- Inhaled medications reduce systemic absorption, but swallowed portions undergo hepatic metabolism.
- Limited community-based data exists on family-perceived effectiveness of asthma treatments.
Purpose of the Study:
- To review current understanding of pediatric asthma therapy administration.
- To highlight the impact of inhaler devices on medication dosage and effectiveness.
- To discuss the declining use of nebulizers in favor of other devices.
Main Methods:
- Literature review of laboratory and community-based studies on asthma medication delivery.
- Analysis of drug deposition characteristics and systemic absorption.
- Evaluation of device-specific efficacy and patient/family perspectives.
Main Results:
- Inhaled route is prevalent, offering reduced systemic absorption compared to other methods.
- Device selection critically influences delivered dose; changes necessitate medication review.
- Large volume spacers with beta(2)-adrenoceptor agonists are effective for most exacerbations, reducing nebulizer use.
Conclusions:
- Inhaler device choice is crucial for effective pediatric asthma treatment and requires careful consideration.
- Community-based evidence on perceived effectiveness is lacking but important for optimizing therapy.
- Optimized use of spacers can manage most asthma exacerbations, decreasing reliance on nebulizers.
Abstract:
Asthma therapy can be administered to children via a number of routes, including oral, inhaled (via a multiplicity of devices), rectal, intravenous, subcutaneous, and intramuscular. The inhaled route is used most often. This can reduce, but never eliminate, systemic absorption. Swallowed aerosolized medication is subject to hepatic first-pass metabolism, but this metabolic route is bypassed by the drug impacting on the airway, including the pharynx. Although there are a large number of studies from a laboratory setting about drug deposition characteristics, there is very little evidence from community-based studies about what families think actually works well in the everyday treatment of the child. However, it is clear that altering the inhaler device can result in marked changes in the dose administered, and any such change should be part of a review of the dose of prescribed medication. Nebulizers are being used much less frequently, and in particular, all but the most severe exacerbations can be treated at least as effectively with equivalent dosages of beta(2)-adrenoceptor agonists from a large volume spacer.