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[Inhalation therapy in children younger than two years. I. From theory to practice]
1Emma Kinderziekenhuis AMC, afd. Kinderpulmonologie, Amsterdam.
Insights
Metered dose inhalers with small chambers are more effective for children than nebulizers, even with severe airway obstruction. This method offers faster, simpler, and cheaper drug delivery for pediatric respiratory conditions.
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.
Abstract:
Effective inhalation of drugs, even by small children under 2 years, is often faster, simpler, cheaper and better with metered dose inhalers with small antistatic (metal) inhalation chambers than with nebulisation. This is also true during considerable bronchial obstruction. It is mandatory that the inhalation chamber has a small dead space and well functioning valves opening at low flows. Effective dosing in small children is enhanced by more doses, given separately, while choosing the highest dose per spray available. Important factors determining bronchial deposition in small children are breathing frequency, tidal volume and the degree of bronchial obstruction and nasal obstruction, since inhalation goes primarily through the nose. If well-performed medication with a small inhalation chamber is clinically ineffective, it is better to start systemic medication, e.g. a corticosteroid, or even to consider artificial ventilation, rather than to try nebulisation. Better effective deposition is possible with inhalation of drugs in hydrofluoroalkane (HFA) aerosols, which will replace chlorofluorocarbon (CFC) aerosols in the near future.