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Aerosol therapy and the fighting toddler: is administration during sleep an alternative?
Hettie M Janssens1, Els C van der Wiel, Anton F M Verbraak
1Department of Pediatrics, Erasmus Medical Center Rotterdam/Sophia Children's Hospital, Rotterdam, The Netherlands.
Insights
Administering pressurized metered dose inhaler (pMDI) aerosols during sleep significantly increases lung dose in infants compared to wakefulness. This method may improve treatment efficiency for uncooperative young children.
Area of Science:
- Pediatric Pulmonology
- Respiratory Drug Delivery
- In Vitro Modeling
Background:
- Pressurized metered dose inhalers (pMDI) with spacers are crucial for treating respiratory conditions in young children.
- Poor cooperation during pMDI administration affects nearly 50% of children under two years old.
- Inhalation during sleep may offer a more efficient alternative, but the lung deposition is unknown.
Purpose of the Study:
- To determine the in vitro lung dose of budesonide delivered via pMDI/spacer in young children during simulated sleep and wake breathing patterns.
- To compare aerosol deposition efficiency between sleep and wake breathing in an infant model.
Main Methods:
- Breathing patterns of 18 infants (11 months average age) were recorded during sleep and wakefulness using a pneumotachograph.
- Recorded breathing patterns were replicated using a computer-controlled breathing simulator attached to an anatomically correct infant nose-throat model.
- Budesonide aerosol (200 µg) was delivered via a metal spacer, and lung dose was quantified using HPLC after aerosol collection on a filter.
Main Results:
- Sleep breathing patterns exhibited significantly lower respiratory rates and peak inspiratory flows compared to wake patterns.
- Lung dose of budesonide was significantly higher during simulated sleep breathing (11.3 ± 3.9 µg) than during wake breathing (6.5 ± 3.2 µg) (p=0.004).
- Variability in respiratory rate, tidal volume, and peak inspiratory flows was also lower during sleep.
Conclusions:
- In vitro infant modeling demonstrates that pMDI/spacer lung deposition is significantly greater during sleep breathing patterns.
- Administering budesonide via pMDI/spacer during sleep presents a potentially more effective alternative for delivering medication to uncooperative young children.
- This finding supports further investigation into sleep-based aerosol administration for pediatric respiratory care.
Abstract:
Insufficient cooperation during administration of aerosols by pressurized metered dose inhaler (pMDI)/spacers is a problem in nearly 50% of treated children younger than 2 years. For these children, administration during sleep might be more efficient. However, it is unknown how much aerosol reaches the lungs during sleep. The aim of this study was to determine in vitro the lung dose in young children from a pMDI/spacer during sleep and while being awake. Breathing patterns were recorded by a pneumotachograph in 18 children (age 11 +/- 5.1 months) during sleep and wakefulness. Next, breathing patterns were replayed by a computer-controlled breathing simulator to which an anatomically correct nose-throat model of a 9-month-old child was attached. One puff of budesonide (200 microg) was administered to the model via a metal spacer. Aerosol was trapped in a filter placed between model and breathing simulator. The amount of budesonide on the filter (5 lung dose) was analyzed by HPLC. For each of the 36 breathing patterns, lung dose was measured in triplicate. The sleep breathing patterns had significantly lower respiratory rate and peak inspiratory flows, and smaller variability in respiratory rate, tidal volume, and peak inspiratory flows. Lung dose (mean +/- SD) was 6.5 +/- 3.2 and 11.3 +/- 3.9 microg (p = 0.004) for the wake and sleep breathing pattern, respectively. This infant model-study shows that the lung dose of budesonide by pMDI/spacer is significantly higher during sleep compared to inhalation during wake breathing. Administration of aerosols during sleep might, therefore, be an efficient alternative for uncooperative toddlers.
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