[Inhalation therapy in children younger than two years. I. From theory to practice]

Area of Science:

• Pediatric Pulmonology
• Respiratory Drug Delivery

Context:

• Metered dose inhalers (MDIs) with small antistatic inhalation chambers offer advantages over nebulization for pediatric patients.
• Effective drug inhalation is crucial, especially for children under 2 years and those with significant bronchial obstruction.

Purpose:

• To evaluate the efficacy of metered dose inhalers with small inhalation chambers compared to nebulization for drug delivery in young children.
• To identify key factors influencing bronchial deposition and optimize inhalation therapy for pediatric respiratory conditions.

Summary:

• Small, valved inhalation chambers with low dead space facilitate faster, simpler, and more cost-effective drug delivery via metered dose inhalers compared to nebulizers, even in cases of severe bronchial obstruction.
• Optimizing pediatric inhalation therapy involves administering multiple doses separately, using the highest available spray dose, and considering factors like breathing patterns and nasal obstruction.
• Hydrofluoroalkane (HFA) aerosols are emerging as a superior alternative to chlorofluorocarbon (CFC) aerosols for enhanced drug deposition.

Impact:

• Provides evidence supporting the use of metered dose inhalers with small chambers as a preferred method for pediatric inhalation therapy.
• Suggests alternative treatment strategies, including systemic medication or mechanical ventilation, if MDI therapy proves ineffective.
• Highlights the future direction of aerosol technology with the transition to HFA-based inhalers for improved therapeutic outcomes.