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Dosage regimens for inhaled therapy in children should be reconsidered
J H Wildhaber1, M Mönkhoff, F H Sennhauser
1Swiss Paediatric Respiratory Physiology Research Group, Department of Respiratory Medicine, University Children's Hospital, Zürich, Switzerland. wildhaber@kispi.unizh.ch
Insights
Current asthma medication dosing for children, based on adult sizes, may be ineffective. Pediatric lung deposition is age-dependent, suggesting current dosing calculations need reevaluation for better treatment outcomes.
Area of Science:
- Pediatric pulmonology
- Pharmacology
- Aerosol science
Background:
- Current asthma guidelines use adult doses for pediatric inhalation therapy, often adjusted by weight or body surface area.
- These dosing recommendations may not align with current understanding of pediatric aerosol therapy.
- Lung deposition is critical for both treatment effectiveness and potential side effects.
Purpose of the Study:
- To evaluate the appropriateness of current adult-based dosing regimens for pediatric inhalation therapy.
- To investigate the relationship between age, body size, and lung deposition in children.
- To determine if current methods of calculating pediatric doses are optimal.
Main Methods:
- Analysis of age-dependent changes in lung deposition of inhaled medications.
- Comparison of lung deposition percentages across different age groups.
- Evaluation of the impact of airway anatomy on aerosol deposition in children.
Main Results:
- Lung drug deposition increases with age in children.
- Lung deposition as a percentage of body weight is independent of age.
- Age-related changes in airway anatomy influence lung deposition.
- Calculating pediatric doses from adult doses based on body size may lead to inadequate lung deposition.
Conclusions:
- Current pediatric asthma dosing strategies based on adult calculations may be suboptimal.
- Pediatric lung deposition is influenced by age-related anatomical factors, not just body size.
- Dosage regimens for pediatric inhalation therapy require reconsideration and should be based on pediatric-specific dose-ranging studies.
Abstract:
In current asthma guidelines, dosage regimens for inhalation therapy in children are based on adult doses and are generally titrated per kilogram of bodyweight or per square metre of body surface area. However, these recommendations do not correspond well with current knowledge of aerosol therapy in childhood. Lung deposition of the aerosolised drug is the key determinant for clinical efficacy and for systemic side effects of inhalation therapy. Lung deposition increases with age, whereas lung deposition expressed as a percentage per kilogram bodyweight is age-independent. This finding is explained by the self-regulating effect of age-dependent airway anatomy on lung deposition. Therefore, it is more likely that adult doses translate into paediatric doses only by virtue of the differences in self-limiting pulmonary deposition when using the same absolute nominal doses of the medication. Adapting the adult dose to a paediatric dose calculated on body size might be unnecessary and could lead to insufficient pulmonary deposition of medication. These findings suggest that dosage regimens for inhalation therapy for children may have to be reconsidered, and should be determined from dose-ranging studies rather than calculated from adult doses based on body size.