Titolo del documento

A longitudinal assessment of the effect of inhaled fluticasone propionate therapy on adrenal function and growth in young children with asthma

Autori e Nazionalità

Iles R, Williams RW, Deeb A, Ross-Russell R, Acerini CL. Gran Bretagna.

Fonte bibliografica

2008 febbr 19 (Epub ehead of print)

Lingua

Inglese

Abstract

OBJECTIVE: Fluticasone proprionate (FP) is increasingly used to treat very young children with asthma. Its safety in terms of effects on the hypothalamic pituitary axis (HPA) and growth in this age group is uncertain. PATIENTS AND METHODS:: Eleven children (median (range) age 10 (5.6-24.3) months) presenting with recurrent wheeze and family history of asthma were studied prospectively for a period of 18 months. Children received daily-inhaled FP 250 microg via a spacer device. No other corticosteroid therapy was administered prior to or during the study. A Short Standard Synacthen Test (SST) (125 microg) was performed pretreatment, and after 6 and 18 months. Weight (Wt), height (Ht), and body mass index (BMI) were measured at 3-6 monthly intervals. RESULTS:: Fasting early morning and peak cortisol levels remained within the normal reference range with therapy. There were no changes in Ht SDS, whereas both Wt SDS (baseline 0.05 (-2.17 to 0.52) vs. +18 months 0.68 (-0.5 to 1.36) P < 0.02) and BMI SDS (-0.22 (-1.73 to 0.75) vs. 0.86 (0.03 to 1.99) P < 0.005) increased after 18 months of treatment. CONCLUSION:: Daily treatment with inhaled FP 250 microg in young children with asthma appears to have no adverse effects on the HPA or on linear growth, however, treatment is associated with increases in body Wt and BMI in young children. Pediatr Pulmonol. (c) 2008 Wiley-Liss, Inc.

 

PMID

PMID: 18286548

Tipo di studio

Osservazionale

Livello di efficacia

2+

Commento

11 bambini di età media 10 mesi con broncospasmo ricorrente, che hanno assunto FP 200 ugr/die X 18 mesi non hanno avuto modifiche della funzionalità surrenalica, come confermato da un test di stimolo breve con  Synacten, nè riduzioni della velocità di crescita. E' stato segnalato un significativo aumento del BMI SDS. Non era previsto alcun gruppo di controllo.

Titolo del documento

Randomized trial of spacers in asthma

Autori e Nazionalità

Dahiya B, Mathew JL, Singh M. India 

Fonte bibliografica

Indian J Pediatr 2007;74(7):631-5.

Lingua

Inglese

Abstract

OBJECTIVE: To compare the efficacy of all types of spacers commonly available to children in India. METHODS: 150 children 5-14 yr of age with persistent asthma presenting with peak expiratory flow (PEF) < 70% of personal best were randomized to receive 200 mg salbutamol through one of five spacers: A) 750 ml spacer with valve, B) 165 ml spacer with valve, C) 250 ml spacer without valve, D) 1000 ml indigenously made spacer without valve and E) 500 ml indigenously made spacer without valve. PEF measurement was repeated 15 minutes later. Children> 8 yr old performed spirometry in addition to PEF. Absolute change and percentage improvement of PEF and FEV1 were compared among the groups. RESULTS: Subjects in all groups had comparable baseline demographic characteristics and PEF. All showed significant improvement in PEF and FEV1 over baseline values. The change in PEF and percentage improvement were comparable among all five groups (p=0.780 and p=0.955 respectively). Likewise change in FEV1 and percentage improvement were also comparable. The five groups showed no difference in efficacy, irrespective of severity of baseline airway obstruction. CONCLUSION: The five spacers were equally efficacious for the delivery of bronchodilator in children with moderate persistent asthma presenting with airway obstruction.

PMID

PMID: 17699970 [PubMed - in process]

Tipo di studio

Randomizzato

Livello di evidenza

1+

Commento

5 distanziatori di volume diverso (da 165 ml a 1000 ml con o senza valvole) sono ugualmente efficaci nel migliorare il FEV1 e il PEF.

Titolo del documento

Valved holding chambesr for use with pressurised metered-dose inhalers: a review of causes of inconsistent medication delivery.

Autori e Nazionalità

Mitchell JP, Nagel MN. Canada

Fonte bibliografica

Primary Care Respir Journal 2007;16:Ahead of print

Lingua

Inglese

Abstract

BACKGROUND: Valved holding chambers (VHCs) are prescribed with pressurised metered dose inhalers (pMDIs) to improve medication delivery for the treatment of respiratory diseases because they reduce the need for the patient to co-ordinate inhaler actuation with the onset of inhalation. Although mechanically robust and clinically effective if properly designed and pre-conditioned, there are several causes of inconsistent medication delivery if this is not the case. These include: electrostatic charge; incorrect operation of inhalation and exhalation valves; and the fit of the facemask - where present - to the face. In addition, behavioral factors, such as not following patient instructions for use and maintenance, and imperfect breathing technique, amplify overall variability. Aids such as valve movement indicators that provide patient feedback are helpful in order to minimise these factors. METHODS: This article reviews recent literature concerning the causes of inconsistent drug delivery and the improvements that have been made by manufacturers to VHC devices, and assesses the clinical implications. The attributes of a well-designed VHC are summarised.

PMID

17625786 [PubMed - as supplied by publisher]

Tipo di studio

Revisione narrativa 

Livello di evidenza

4

Commento

I fattori che influenzano la quota di farmaco che spruzzata nel distanziatore arriva al paziente: il volume, le valvole, il disegno e le caratteristiche della mascherina, le cariche elettrostatiche

Italiano

L’Areosol classico, sia quello a compressore che quello ad ultrasuoni è oggi superato sia per la variabilità e comunque scarsa qualità del nebulizzato, sia per il tempo richiesto per l’esecuzione. La polvere per inalazione non solo è inutilizzabile nella broncoostruzione acuta, ma presenta una serie di difficoltà da renderne l’impiego difficile nel bambino in genere e addirittura impossibile sotto i 6 anni. Un progresso oggi ineguagliabile è rappresentato dallo spray+distanziatore. Il passaggio allo spray+distanziatore avviene però molto lentamente in parte per il fascino che l’aerosol  classico continua ad esercitare in parte perché la nuova metodica ha evidenziato la necessità di una serie di accorgimenti fino ad ora ignorati come quello di evitare che il bambino pianga durante la terapia. Di qui la necessità per il pediatra di famiglia e ospedaliero di mantenersi aggiornato e di trasmettere le nuove conoscenze ai genitori insistendo sulle dimostrazioni pratiche da ripetere e controllare alle successive  visite ambulatoriali.

testo

Revisione narrativa

4

Titolo del documento

Randomised controlled trial of the efficacy of a metered dose inhaler with bottle spacer for bronchodilator treatment in acute lower airway obstruction

Autori e Nazionalità

Zar HJ, Streun S, Levin M, Weinberg EG, Swingler GH

Fonte bibliografica

Arch Dis Child 2007;92:142-146

Lingua

Inglese

Abstract

BACKGROUND: Inhaled bronchodilator treatment given via a metered dose inhaler (MDI) and spacer is optimal for relief of bronchoconstriction. Conventional spacers are expensive or unavailable in developing countries, but there is little information on the efficacy of low-cost spacers in young children. OBJECTIVE: To compare the response to bronchodilator treatment given via a conventional or a low-cost bottle spacer METHODS: A randomised controlled trial of the efficacy of a conventional spacer compared with a bottle spacer for bronchodilator treatment in young children with acute lower airway obstruction. Bronchodilator treatment was given from an MDI via an Aerochamber or a bottle spacer. Clinical score and oximetry recording were carried out before and after 15 min of treatment. MDI-spacer treatment was repeated up to three times, depending on clinical response, after which nebulisation was used. The primary outcome was hospitalisation. RESULTS: 400 children, aged (median (25th-75th centile)) 12 (6-25) months, were enrolled. The number of children hospitalised (n = 60, 15%) was identical in the conventional and bottle spacer groups (n = 30, 15% in each). Secondary outcomes including change in clinical score (-2 (-3 to -1)), oxygen saturation (0 (-1 to 1)) and number of bronchodilator treatments (2 (1 to 3)) were similar in both groups. Oral corticosteroids, prescribed for 78 (19.5%) children, were given to a similar number in the conventional (37 (18.5%)) and bottle spacer groups (41 (20.5%)). CONCLUSION: A low-cost bottle spacer is as effective as a conventional spacer for bronchodilator treatment in young children with acute obstruction of the lower airways

PMID

16905564 [PubMed - indexed for MEDLINE]

Tipo di studio

Randomizzato controllato

Livello di evidenza

1+

Commento

Titolo del documento

Lo spray con il distanziatore:istruzioni per l'uso

Autori e Nazionalità

Radzik D.Italia

Fonte bibliografica

Medico e Bambino settembre 2007, in press

Lingua

Italia

Abstract

There is clear evidence to support the use of a pressurized metered dose inhaler (pMDI)/spacer combination in the treatment of mild to moderate acute asthma rather than a nebulizer. With the first method there are additional benefits like fewer side effects and less time spent in the Emergency Department; furthermore spacers are cheaper and more portable. Nevertheless physicians, nurses, patients and their relatives seldom use this technique: reasons for this “nebulizer culture” are briefly analyzed and useful tips of best clinical practice on this topic are presented.

PMID

testo

Tipo di studio

Revisione

Livello di evidenza

Commento

Titolo del documento

In vitro evaluation of the novel spacer device Watchhaler and modeling of probable deposition in children.

Autori e Nazionalità

Scheuch G, Kolb T, Sommerer K, Roeder S. Germania

Fonte bibliografica

Respir Drug Deliv 2006;10:1-3 

Lingua

Inglese

Abstract

In vitro il nuovo spacer Watchhaler dotato di incentivatore dimostra di poter raggiungere un'alta deposizione polmonare ed output del farmaco inalato.

PMID

Non presente in PubMed 

Tipo di studio

in vitro

Livello di evidenza

Commento

Sono necessari studi in vivo sul paziente di conferma

Titolo del documento

Aerosol therapy: the special need of young children.

Autori e Nazionalità

Janssenss HM, Tiddens HA. Olanda

Fonte bibliografica

Paediatr Respir Rev 2006; 7 Suppl 1:S83-5

Lingua

Inglese

Abstract

One third of young children are distressed during inhalation therapy. It has been suggested that administration during sleep could be a good alternative for these children. A laboratory study in our department using an infant upper airway model showed significantly higher lung doses from a pressured metered-dose inhaler (pMDI)-spacer for sleep-breathing patterns compared with wake-breathing patterns. OBJECTIVE: We set up a daily life study to investigate the feasibility of aerosol administration by means of pMDI-spacer in sleeping young children. DESIGN: Over a period of 3 weeks, 30 children (age range, 6 to 23 months) with recurrent wheeze daily inhaled 1 puff of budesonide aerosol (200 mug) while awake and 1 puff during sleep. Filters positioned between the chamber and the facemask trapped the budesonide aerosol. Parents scored the child's asthma symptoms, degree of cooperation, and feasibility of administration on diary cards. RESULTS: In 69% of the sleep administrations, the children woke up, and in 75% of these cases the children were distressed. The mean filter dose (expressed as the percentage of the nominal dose) while awake was 47%, and during sleep it was 16% (p = 0.007). The median within-subject dose variability while awake was 50%, and during sleep it was 110% (p = 0.007). CONCLUSION: Aerosol administration by means of pMDI-spacer during sleep offers no advantage and is not a feasible treatment option in most young children.

 

PMID

16899849 [PubMed - indexed for MEDLINE]

Tipo di studio

Revisione narrativa

Livello di evidenza

4

Commento

Un'ottimale deposizione dell'aerosol può essere raggiunta con una buona aderenza della mascherina al viso, una buona collaborazione del paziente e un respiro tranquillo

Titolo del documento

Bronchodilators via metered-dose inhaler with spacer in the pediatric emergency department: what is the dosage ?

Autori e Nazionalità

Benito Fernandez J, Trebolazabala QN, Garriz LM, Raso MS, Diaz GC. Spagna

Fonte bibliografica

An Pediatr 2006;64:46-51

Lingua

Inglese

Abstract

INTRODUCTION: Bronchodilators administrated through a metered-dose inhaler (MDI) with spacer are as effective as nebulizers in the treatment of acute asthma exacerbations in childhood. However, consensus is lacking on the most suitable dosage. OBJECTIVE: To assess the effectiveness of distinct salbutamol and terbutaline doses delivered via an MDI with spacer for the treatment of acute asthma in the pediatric emergency department. METHODS: This was a prospective, double-blind randomized study. All consecutive children (n = 324) between 2 and 14 years of age with acute asthma exacerbations treated in the pediatric emergency department between October 1 and November 30, 2004, were included. Two treatment groups were established: one group received a number of puffs equivalent to half the child's weight (1 puff of salbutamol = 100 microg and 1 puff of terbutaline = 250 microg) and the other group received a number of puffs equivalent to one-third of the child's weight. RESULTS: Three hundred twenty-four episodes were studied; there were 164 children in the first group and 160 in the second. There were no significant differences between the two groups in the mean (6 SD) age (58.34 +/- 34.72 vs 66.04 +/- 36.45 months), arterial oxygen saturation (95.49 +/- 1.93 vs 95.56 +/- 1.97) or pulmonary score (4.04 +/- 1.55 vs 3.97 +/- 1.51) at recruitment and after treatment in the emergency department (arterial oxygen saturation [96.34 +/- 1.60 vs 96.18 +/- 1.77], pulmonary score [1.87 +/- 1.33 vs 1.64 +/- 1.31]). The number of doses administered (2.17 +/- 0.91 vs 2.24 +/- 1.00) and the hospitalization rate (8.56 % vs 6.87 %) were also similar in both groups. CONCLUSIONS: The distinct bronchodilator doses administered via an MDI with spacer showed similar effectiveness. These findings should contribute to a reevaluation of the use of high doses of bronchodilators, at least in most acute asthma exacerbations in children.

 

PMID

16539916 [PubMed - indexed for MEDLINE]

Tipo di studio

Osservazionale

Livello di evidenza

3

Commento

Qual'è il dosaggio ottimale del broncodilatatore somministrato con lo spray e il distanziatore nell'attacco acuto d'asma. Questo articolo propone delle risposte.

Titolo del documento

Metered-dose inhaler with spacer vs nebulization for severe and potentially severe acute asthma treatment in the pediatric emergency department.

Autori e Nazionalità

Sannier N, Timsit S, Cojocaru B, Leis A, Wille C, garel D, Bocquet N, Chéron G. Francia

Fonte bibliografica

Arch Pediatr 2006;13:238:44.

Lingua

Francese

Abstract

OBJECTIVE: To compare treatment with beta 2 agonist delivered either by a spacer device or a nebulizer in children with severe or potentially severe acute asthma. METHODS: In this randomized trial, children 4 to 15 years, cared for in the emergency department for severe or potentially severe acute asthma, received 6 times either nebulizations of salbutamol (0.15mg/kg) or puffs of a beta 2 agonist (salbutamol 50 microg/kg or terbutaline 125 microg/kg). The primary outcome was the hospitalization rate. Secondary outcomes included percentage improvement in Bishop score, in PEF, SaO(2), respiratory and heart rates, side effects, length of stay and relapses 10 and 30 days later. RESULTS: Groups did not differ for baseline data. There were no significant differences between the 2 groups (nebulizer N=40, spacer N=39) for baseline characteristics before emergency department consultation except for length of acute asthma in the spacer group. Clinical evolution after treatment, hospitalization rate, relapse were similar including the more severe subgroup. In the spacer group, tachycardia was less frequent (P<0.02). The overall length of stay in the emergency department was significantly shorter (148+/-20 vs 108+/-13 min, P<10(-9)). CONCLUSIONS: The administration of beta 2 agonist using a metered-dose inhaler with spacer is an effective alternative to nebulizers for the treatment of children with severe or potentially severe acute asthma in the emergency department. Time gained can be used for asthma education.

 

PMID

16423517 [PubMed - indexed for MEDLINE]

Tipo di studio

Randomizzato

Livello di evidenza

1+

Commento

Un altro tassello del confronto spray con il distanziatore vs nebulizzatore nel trattamento dell'accesso acuto d'asma tramite broncodilatatori

Titolo del documento

Randomized controlled trial of salbutamol aerosol therapy via metered dose inhaler-spacer vs jet nebulizer in young children with wheezing

Autori e Nazionalità

Deerojanawong J, Manuyakorn W, Prapphal N, Harnruthakorn C, Sritippayawan S, Samransamruajkit R. Tailandia 

Fonte bibliografica

Pediatr Pulmonol 2005;39:466-72 

Lingua

Inglese

Abstract

The jet nebulizer is a common device used for administering aerosol medication in young children. However, compared to a metered dose inhaler-spacer (MDI-spacer), it takes more time and personnel. This study aimed to compare the efficacy of salbutamol aerosol therapy given via these two devices in young wheezing children. A prospective randomized, double-blind, placebo-controlled trial was performed in children up to 5 years old who had acute wheezing and were admitted to the Department of Pediatrics, King Chulalongkorn Memorial Hospital. Patients were randomly divided into two groups. The first group received 2 puffs of placebo via MDI-spacer, followed by 0.15 mg/kg salbutamol respiratory solution via jet nebulizer. The second group received 2 puffs (100 microg/puff) of salbutamol via MDI-spacer, followed by placebo via jet nebulizer. Clinical scores and tidal breathing pulmonary function test were evaluated before and after treatment. Pulmonary function parameters included those derived from flow volume loops (volume to peak tidal expiratory flow over total expiratory volume, V(PTEF)/V(E); time to peak tidal expiratory flow over total expiratory time, T(PTEF)/T(E); and ratio of tidal expiratory flow at 25% remaining expiration to peak expiratory flow, 25/PF), compliance (Crs), and resistance (Rrs) of the respiratory system. The efficacy of both methods was compared by using analysis of covariance. Forty-seven wheezing children were studied (24 received salbutamol via MDI-spacer, and 23 received it via jet nebulizer). There was no statistical difference between the two groups regarding clinical scores and all pulmonary function parameters. However, heart rate was significantly increased after treatment in the jet nebulizer group when compared to those in the MDI-spacer group (P = 0.004). In conclusion, the efficacy of salbutamol aerosol therapy via MDI-spacer compared to jet nebulizer in young wheezing children was not different in terms of clinical score and postbronchodilator pulmonary function parameters. However, salbutamol aerosol therapy via jet nebulizer significantly increased the heart rate when compared to the MDI-spacer.

PMID

15786440 [PubMed - indexed for MEDLINE]

Tipo di studio

Randomizzato, in doppio cieco

Livello di evidenza

1+

Commento

Confronto spray con il nebulizzatore vs nebulizzatore per somministrare i broncodilatatori nell'asma acuto nei bambini dell'età prescolare

Titolo del documento

The role of the MDI and DPI in Pediatric patients: "children are not just miniature adults"

Autori e Nazionalità

Ahrens RC. Usa

Fonte bibliografica

Respir Care 2005;50:1323-1330

Lingua

Inglese

Abstract

Metered-dose inhalers (MDIs) and dry powder inhalers play an important role in the treatment of asthma in children of all ages. Yet these devices, which were originally developed for use in adults, interact differently with children. Through childhood there are progressive changes in pharmacokinetic handling and pharmacodynamic effects of inhaled antiasthmatic drugs, in the efficiency and distribution of aerosolized drugs in the respiratory tract, and in the patient's ability to successfully use aerosol devices. This, in turn, produces changes in potential for producing efficacy and adverse effects, and in the balance between risk and benefit. These differences from adults are greatest for children under 4-5 years of age, who are unable to use DPIs or unassisted MDIs, and who therefore must rely on nebulizers and MDIs with valved holding chambers for inhaled drug delivery. Unfortunately, there are no drugs approved for delivery via MDI (with holding chamber) in children under 4 years of age, and there are insufficient data to ensure that many of the available drug-MDI-holding-chamber combinations are both safe and effective. In particular, the potential for effects of inhaled corticosteroids on growth are insufficiently studied in this age group and remains a concern. It is likely that the risk of adverse effects on growth are different for each of the many possible MDI/valved-holding-chamber combinations.

PMID

16185368 [PubMed - indexed for MEDLINE]

Tipo di studio

Revisione narrativa

Livello di evidenza

4

Commento

Differenze fra adulti e bambini riguardo alle modalità di deposizione nelle vie aeree dei farmaci inalatori

Titolo del documento

Nebulizers or pressurized metered dose inhalers in the treatment of asthma exacerbations.

Autori e Nazionalità

Radzik D, Peroni DG, Pescollderung L, Piacentini GL, Chatzmichail A, Boner

Fonte bibliografica 

Allergy Asthma Proc 2005;26:207-209

Lingua

Inglese

Abstract

The use of inhaled beta2-agonists delivered by a metered-dose inhaler (MDI) with a holding chamber (spacer) actually is considered the best treatment for childhood acute asthma. However, its use in daily practice still seems rather limited. The aim of this study was to investigate, using a questionnaire, the use of a nebulizer or MDI as the first-line method for delivering inhaled beta2-agonists in children with acute asthma. A questionnaire was developed and distributed to 22 pediatric departments and to 131 family pediatricians (FPs) in northeast Italy. We showed that in the hospitals the episodes of acute asthma usually were treated with bronchodilators administered by wet nebulization (95.45%). This was the case also for FPs (70.9%). However, 29.1% of FPs usually advised the use of an MDI/holding chamber to children with acute asthma. Despite the established efficacy of inhaled beta2-agonists administrated with an MDI compared with wet nebulization in acute asthma, this practice still is rather limited. The use of wet nebulization was more evident in hospital settings compared with community medicine. Emergency room visits may represent a missed opportunity to promote an effective method of delivering bronchodilators in childhood asthma.

 

PMID

16119036 [PubMed - indexed for MEDLINE]

Tipo di studio

Osservazionale

Livello di evidenza

3

Commento

il distanziatore viene usato di preferenza per somministrare i broncodilatatori nell'attacco acuto d'asma solo da 1 U.O di Pediatria su 22 del Veneto e Trentino Alto Adige e da 1 Pediatria di famiglia su 3

Titolo del documento

Evaluation of particle size distribution of albuterol sulfate hydrofluoroalcane administered via metered-dose inhaler with or without holding chambers.

Autori e Nazionalità

Crim C, Holmes M, Lee B, Cavanaugh R,Lincourt W. Usa 

Fonte bibliografica

Ann Allergy Asthma immunol 2005;94;80-85.

Lingua

Inglese

Abstract

BACKGROUND: Administration of inhaled medications via metered-dose inhaler (MDI) to pediatric patients younger than 4 years usually requires use of a holding chamber or spacer with an attached face mask. OBJECTIVE: To determine the particle size distribution and overall dose of albuterol from the albuterol sulfate hydrofluoroalkane delivered in conjunction with 2 US-marketed valved holding chambers (VHCs) compared with the dose delivered via MDIs without VHCs. METHODS: Cascade impaction methods with high-performance liquid chromatography were used to evaluate the fine particle mass (FPM) of albuterol administered without and with the use of 2 commercially available VHCs. RESULTS: Particle size distributions for the 2 VHCs and the control were similar. The mean FPM values for the 2 VHCs and the control were 32, 28, and 30 microg, respectively. Statistical comparison of the FPM shows a similar profile when differences from the albuterol hydrofluoroalkane without a spacer were evaluated. CONCLUSIONS: In vitro results obtained under these test conditions demonstrate that all the FPM values for the VHCs tested were within 15% of the control range, a difference that is unlikely to be clinically meaningful. These results do not warrant a change in the recommended dose of albuterol hydrofluoroalkane administered when using the VHCs tested. The use of an MDI in conjunction with a VHC provides a reasonable therapeutic approach for administration of albuterol hydrofluoroalkane to young children and other patients who have difficulty administering the MDI alone.

PMID

15702821 [PubMed - indexed for MEDLINE]

Tipo di studio

Osservazionale

Livello di evidenza

2+

Commento

 

Titolo del documento

Le treatment inhalé en pratique

Autori e Nazionalità

Pham Ti Thuong, Le Bourgeois M, de Blic J. Scheimann P. Francia

Fonte bibliografica

Archives de pédiatrie 2004;11:1377-1383

Lingua

Francese

Abstract

The modalities of an inhaled treatment depends on the characteristics of the aerosol, on the age of the child, and mainly on the inhalatory system. Before the age of 8 years, the pressurised metered dose inhaler must be used together with a spacer device. Above this age, the use of a breath-actuated inhaler or of a dry powder inhaler can be proposed. Demonstration and educational instructions will increase the probability of compliance and efficiency of the treatment

PMID

15519840 [PubMed - indexed for MEDLINE]

Tipo di studio

Narrativo

Livello di evidenza

4 (Opinione di un esperto)

Commento

Con lo spray e il distanziatore con il boccaglio la deposizione polmonare dell'aerosol è del 6% nel bambino e del 2% quando si usa il distanziatore con la maschera (0.4% in caso di pianto)

Titolo del documento

Bacterial contamination of spacer devices used by children with asthma.  

Autori e Nazionalità

Cohen HA, Cehen Z, kahan E. Israele

Fonte bibliografica

JAMA 2003;290:195-6

Lingua

Inglese

Abstract

Con questa lettera gli autori israeliani segnalano di aver trovato un’alta contaminazione da Pseudomonas speciei sia nel reservoir (23%) sia nella mascherina (13,3%) dei distanziatori “personali” di bambini che utilizzavano routinariamente questa tecnica

PMID

12851272 PubMed 

Tipo di studio

di laboratorio 

Livello di evidenza

Commento

Titolo del documento

Nebulizers vs metered-dose inhalers with spacers for bronchodilator therapy to treat wheezing in children aged 2 to 24 months in a paediatric emergency department.

Autori e Nazionalità

Delgado A, Chou KJ, Silver EJ, Crain EF. Usa.

Fonte bibliografica

Arch Pediatr Adolesc Med 2003;157:76-80.

Lingua

Inglese

Abstract

OBJECTIVE: To determine if administration of albuterol by a metered-dose inhaler with a spacer device is as efficacious as administration of albuterol by nebulizer to treat wheezing in children aged 2 years and younger. DESIGN: Double-blind, randomized, placebo-controlled clinical trial. SETTING: Pediatric emergency department. PATIENTS: From a convenience sample of wheezing children aged 2 to 24 months, 85 patients were enrolled in the nebulizer group and 83 in the spacer group. INTERVENTIONS: The nebulizer group received a placebo metered-dose inhaler with a spacer followed by nebulized albuterol. The spacer group received albuterol by a metered-dose inhaler with a spacer followed by nebulized isotonic sodium chloride solution. Treatments were given every 20 minutes by a single investigator blinded to group assignment. MAIN OUTCOME MEASURES: The primary outcome was admission rate. Pulmonary Index score and oxygen saturation were measured initially and 10 minutes after each treatment. RESULTS: The nebulizer group had a significantly higher mean (SD) initial Pulmonary Index score compared with the spacer group (7.6 [2.5] vs 6.6 [2.0]; P =.002). With the initial Pulmonary Index score controlled, children in the spacer group were admitted less (5% vs 20%; P =.05). Analyses also revealed an interaction between group and initial Pulmonary Index score; lower admission rates in the spacer group were found primarily in children having a more severe asthma exacerbation. CONCLUSION: Our data suggest that metered-dose inhalers with spacers may be as efficacious as nebulizers for the emergency department treatment of wheezing in children aged 2 years or younger.

PMID

12517199 [PubMed - indexed for MEDLINE]

Tipo di studio

Randomizzato

Livello di evidenza

1+

Commento

Spray con il distanziatore vs nebulizzatore per somministrare i broncodilatatori nella terapia dell'attacco acuto d'asma

Titolo del documento

Cough after inhalation of corticosteroids delivered from spacer devices in children with asthma

Autori e Nazionalità

Dubus JC, Mély L, Huiart L, Marguet C, Le Roux P. Francia

Fonte bibliografica

Fundam Clin Pharmacol 2003;17:627-31

Lingua

Inglese

Abstract

Children using a spacer device rather than another device for delivering inhaled corticosteroids (ICS) has been identified as a risk factor for cough immediately after inhalation. The aim of this study was to point out the different factors influencing the occurrence of such lateral side-effects. We studied this local side-effect in 402 asthmatic children (55.6 +/- 34.9 months; 65.6% boys) treated for at least 1 month with beclomethasone dipropionate (n = 331), budesonide (n = 47) or fluticasone propionate (n = 24) delivered from pressurized metered-dose inhalers and small (75.1%) or large volume (24.8%) spacer devices mainly used with face mask (90.7%). A total of 219 patients (54.5%), treated with either high doses of ICS or ICS and long-acting beta2-agonist, were considered as having severe asthma. Cough was reported after each inhalation of corticosteroids in 216 patients (53.7%). Among them, about 30% also complained of cough with beta2-agonists. Despite different propellants and dispersants, all corticosteroids induced cough similarly. Cough was not linked with asthma severity, but was significantly related to therapy duration and use of long-acting beta2-agonist. Type and volume of the spacer device, use of a face mask or mouthpiece were not influencing factors. Cough after inhalation of corticosteroids delivered from spacer devices is a frequent local side-effect in children with asthma. This side effect can greatly alter compliance. A practitioner must be sought at each visit.

PMID

14703724 [PubMed - indexed for MEDLINE]

Tipo di studio

Osservazionale

Livello di evidenza

3

Commento

La tosse può essere frequente durante l'inalazione con i corticosteroidi somministrati con il distanziatore e questo fattore può influenzare la compliance alla terapia

Titolo del documento

Adrenal suppression in asthmatic children receiving low-dose inhaled budesonide: comparison between dry powder inhaler and pressurized metered-dose inhaler attached to a spacer.

Autori e Nazionalità

Goldberg S, Einot T, Algur N, Schwartz S, Greenberg AC, Picard E, Virgilis D, Kerem E. Israele

Fonte bibliografica

Ann Asthma Allergy Immunol 2002;89:566-571.

Lingua

Inglese

Abstract

BACKGROUND: Dry powder inhalers (DPI) have in recent years become a common mode for administration of inhaled corticosteroids for preventive therapy of asthma. Inhaled steroids delivered by DPI achieve increased lung deposition compared with pressurized metered-dose inhalers (pMDI), which is associated with increased therapeutic effect. This may be associated with increased systemic absorption. OBJECTIVE: The purpose of this study was to evaluate the prevalence of adrenal suppression in children using low-dose budesonide given by DPI, as compared with pMDI attached to a large-volume spacer device (pMDI + spacer). METHODS: In an open-labeled crossover study, 15 asthmatic children aged 5 to 15 years received 200 microg of inhaled budesonide twice daily by DPI (Turbuhaler, Astra, Draco AB, Lund, Sweden) and by pMDI + spacer, 1 month each, in a randomized order. Twenty-four-hour urine collections were performed at baseline and at the end of each of the 2 months of the study period, and urinary cortisol and creatinine were measured. RESULTS: Baseline urinary cortisol:creatinine was 0.038 +/- 0.012 microg/mg, similar in both groups. After 1 month of DPI therapy, urinary cortisol:creatinine was reduced by 27 +/- 16% to 0.028 +/- 0.012 microg/mg (P = 0.018). Urinary cortisol:creatinine after 1 month of pMDI + spacer therapy was similar to baseline 0.037 +/- 0.019 microg/mg (P = 0.78). CONCLUSIONS: Treatment of asthmatic children with budesonide 400 microg daily given via a DPI for 1 month was associated with hypothalamic-pituitary-adrenal axis suppression. This effect was not observed with the same dose of budesonide administered via pMDI + spacer. This indicates that systemic absorption might be reduced with pMDI + spacer therapy.

PMID

12487221 [PubMed - indexed for MEDLINE]

Tipo di studio

Osservazionale

Livello di evidenza

3

Commento

Il trattamento per un mese con budesonide 400 ugr die in 15 asmatici di età 5-15 anni è associata con una soppressione dell'asse ipotalamo ipofisario, misurata tramite il dosaggio del cortisolo libero urinario. Un tale comportamento non si osserva con l'utilizzo dello stesso farmaco somministrato con lo spray con il distanziatore. E' stato arruolato in questo studio cross sectional uno scarso numero di partecipanti.

Titolo del documento

A 500- ml plastic bottle: an effective spacer for children with asthma

Autori e Nazionalità

Zar HJ, Asmus MJ, Weinberg EG. Sud Africa

Fonte bibliografica

Pediatr Allergy Immnuol 2002;13:217-222

Lingua

Inglese

Abstract

Inhaled therapy using a metered-dose inhaler (MDI) with attached spacer has been increasingly recognized as the optimal method for delivering asthma medication for acute attacks and chronic prophylaxis. However, in developing countries the cost and availability of commercially produced spacers limit the use of MDI-spacer delivery systems. A 500-ml plastic bottle has been recently adapted to function as a spacer. This article reviews the current data on the efficacy of this bottle-spacer and discusses its advantages and limitations. It is concluded that a modified 500-ml plastic bottle is an effective spacer; modification and use of this device should be incorporated into international guidelines for the management of children with asthma.

PMID

12144645 [PubMed - indexed for MEDLINE]

Tipo di studio

Osservazionale

Livello di evidenza

3

Commento

Ecco come Zar ha preparato il suo distanziatore "fatto in casa": ha preso una bottiglia di plastica da 500 ml delle bibite, poi alla base ha applicato per 10 secondi un marchio di metallo incandescente che aveva la forma del beccuccio dello spray. Lo spray di plastica veniva applicato subito, mentre la base della bottiglia era ancora calda in modo da creare una stretta adesione. In questo modo lo spray rimaneva sigillato dentro la plastica. Nei bambini di età < 3 anni veniva inserita nella parte anteriore una mascherina di plastica

Titolo del documento

Dosage regimens for inhaled therapy in children should be reconsidered 

Autori e Nazionalità

Wildhaber JH, Monkhoff M, Sennhauser FH. Svizzera 

Fonte bibliografica

J Paediatr Child Health 2002;38:115-116

Lingua

Inglese

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.

PMID

12030988 [PubMed - indexed for MEDLINE]

Tipo di studio

narrativo

Livello di evidenza

4

Commento

La deposizione polmonare aumenta e quella orofaringea diminuisce con l'età a causa dell'anatomia delle vie aeree: in conseguenza i dosaggi dei farmaci somministrati come aerosol non dovrebbero essere espressi pro/kg, ma andrebbero riconsiderati sulla base di queste considerazioni.

Titolo del documento

Successful implementation of spacer treatment guideline for acute asthma.

Autori e Nazionalità

Powell CVE, Maskell GR, Marks MK, South M, Robertson CF. Australia

Fonte bibliografica

Arch Dis Child 2001;84:142-146

Lingua

Inglese

Abstract

AIMS: To develop and implement an evidence based guideline for the treatment of acute asthma using a metered dose inhaler and spacer combination. METHODS: Defined strategies were used for the development and implementation of a guideline, assessed by a prospective, descriptive, study using notes review, and patient, nursing, and medical staff telephone contact. The setting was a tertiary referral hospital in Victoria, Australia with 25 000 yearly admissions, and asthma accounting for about 7% of total. The first 200 children and families to use the guideline after its introduction were evaluated. RESULTS: A total of 191 (95.5%) children were treated according to the guideline. Six (3.0%) children were given nebulisers appropriately based on severity; five (2.5%) were given nebulisers at parental or child choice; and four (2.0 %) who did not have severe asthma, received nebulised treatment inappropriately. CONCLUSIONS: Successful implementation of a new evidence based guideline can be achieved using specific strategies for promoting the application of research findings in the clinical arena.

PMID

11159290 [PubMed - indexed for MEDLINE]

Tipo di studio

Osservazionale

Livello di evidenza

3

Commento

Come riuscire a trasformare lo spray con il distanziatore la metodica preferita per somministrare i broncodilatatori nell'attacco acuto d'asma in un grande ospedale pediatrico australiano

Titolo del documento

Metered-dose inhaler: the Emergency Department Orphan

Autori e Nazionalità

Tien I, Dorfman D, Kastner B, Bauchner H. USA

Fonte bibliografica

Arch Pediatr Adolesc Med 2001;155:1335-1339 

Lingua

Inglese

Abstract

OBJECTIVE: Physicians providing emergency department care to children primarily use nebulizers for the delivery of bronchodilators and these physicians have misconceptions regarding the advantages and disadvantages of using metered-dose inhalers (MDIs) with a spacer (MDI + S) for acute asthma exacerbations. DESIGN: Self-administered mail survey. SETTING: Emergency department. PARTICIPANTS: Emergency medicine section members of the American Academy of Pediatrics and Canadian Pediatric Society. INTERVENTIONS: Bronchodilator delivery methods in acute pediatric asthma. MAIN OUTCOME MEASURES: The 2 principal outcomes for bivariate analysis were self-reported nebulizer use in all patients and MDI + S use in patients with mild acute asthma. RESULTS: Of eligible physicians, 333 (51%) of 567 responded. The majority were dual trained in pediatrics and pediatric emergency medicine (72%) and practiced full time (83%) in an urban (83%) pediatric emergency department (80%). The most commonly cited advantages of MDIs were their cost (33%) and speed of use (28%). The most commonly cited disadvantages were patient or parent dissatisfaction (24%) and relative ease of nebulizer use (23%). Only 10% to 21% of participants used MDIs in the emergency department and reserved this delivery method for children with mild asthma exacerbations. There were no significant associations between selected respondent demographic variables and the use of MDIs. CONCLUSIONS: Misconceptions regarding the efficacy and safety of MDI + S for the treatment of acute asthma exacerbations exist but are limited to a minority of surveyed emergency medicine physicians caring for children. Nebulizers remain the preferred method of routine bronchodilator delivery by physicians providing care to pediatric asthmatics in the emergency department

PMID

11732952 [PubMed - indexed for MEDLINE]

Tipo di studio

Osservazionale

Livello di evidenza

3

Commento

Lo spray con il distanziatore:..... l'orfano dei Pronto Soccorso

Titolo del documento

Costs and effectiveness of spacer versus nebulizer in young childre with moderate and severe acute asthma.

Autori e Nazionalità

Leversha AM, Campanella SG, Aickin RP, Asher MI 

Fonte bibliografica

J Pediatr 2000;136:497-502

Lingua

Inglese

Abstract

OBJECTIVE: To compare the costs and effectiveness of albuterol by metered dose inhaler (MDI) and spacer versus nebulizer in young children with moderate and severe acute asthma. DESIGN: Randomized, double-blind, placebo-controlled trial in an emergency department at a children's hospital. The participants were children 1 to 4 years of age with moderate to severe acute asthma. Patients assigned to the spacer group received albuterol (600 microg) by MDI by spacer (AeroChamber) followed by placebo by nebulizer (n = 30). The nebulizer group received placebo MDI by spacer followed by 2.5 mg albuterol by nebulizer (n = 30). Treatments were repeated at 20-minute intervals until the patient was judged to need no further doses of bronchodilator, or a total of 6 treatments. RESULTS: Clinical score, heart rate, respiratory rate, auscultatory findings, and oxygen saturation were recorded at baseline, after each treatment, and 60 minutes after the last treatment. Baseline characteristics and asthma severity were similar for the treatment groups. The spacer was as effective as the nebulizer for clinical score, respiratory rate, and oxygen saturation but produced a greater reduction in wheezing (P =.03). Heart rate increased to a greater degree in the nebulizer group (11.0/min vs 0.17/min for spacer, P <.01). Fewer children in the spacer group required admission (33% vs 60% in the nebulizer group, P =.04, adjusted for sex). No differences were seen in rates of tremor or hyperactivity. The mean cost of each emergency department presentation was NZ$825 for the spacer group and NZ$1282 for the nebulizer group (P =.03); 86% of children and 85% of parents preferred the spacer. CONCLUSION: The MDI and spacer combination was a cost-effective alternative to a nebulizer in the delivery of albuterol to young children with moderate and severe acute asthma.

PMID

10753248 [PubMed - indexed for MEDLINE]

Tipo di studio

Randomizzato

Livello di evidenza

2+

Commento

E' uno dei pochi SCR che confronta spacer vs nebulizzatori nell'attacco acuto d'asma, anche dal punto di vista della spesa: con i distanziatori si avrebbe una riduzione del 40% dei costi rispetto alla terapia tradizionale

Rubilar L, Castro-Rodriguez JA, Girardi G. Cile

Pediatr Pulmonol 2000;29:264-269

Inglese 

 The aim of this study was to compare the efficacy of salbutamol delivered via a metered-dose inhaler with a spacer and facial mask (MDI-S) vs. a nebulizer (NEB) for the treatment of acute exacerbations of wheezing in children. In a single-blind, prospective, randomized clinical trial, 123 outpatients (1-24 months of age), presenting with "moderate to severe" wheezing, were seen in the emergency department. Children were randomly assigned to one of two salbutamol treatment groups. In the first hour, the MDI-S group received 2 puffs (100 microg/puff) every 10 min for 5 doses, and the NEB group received 0.25 mg/kg every 13 min for 3 doses. If the clinical score was >5 at the end of the first hour, the patients received another hour of the same treatment and also betamethasone (0.5 mg/kg intramuscular). On enrollment and after the first and the second hour of treatment each child had a validated clinical score assigned by a blinded investigator. There were no differences at the time of admission to the emergency department between groups in clinical score or demographic data. Success (clinical score </=5) after the first hour of treatment was 90% (56/62) in the MDI-S group and 71% (43/61) in the NEB group (odds ratio 3.9, 95% confidence interval 1.5-10.4, P = 0.01). After the second hour, the success was 100% in the MDI-S and 94% in the NEB (P > 0.05). We conclude that in this study population, children less than 2 years of age with moderate-severe exacerbations of wheezing responded faster to salbutamol delivered by MDI with a spacer and facial mask than to salbutamol delivered by nebulizer.

10738013 [PubMed - indexed for MEDLINE]

Randomizzato, in singolo cieco

1+

Titolo del documento

Is nebulized aerosol treatment necessary in teh Pediatric Emergency Department ? 

Autori e Nazionalità

Mandelberg A, Tsehori S, Houri S, Gilad E, Morag B, Priel EI. Israele

Fonte bibliografica

Chest 2000;117:1309-1313

Lingua

Inglese

Abstract

BACKGROUND: Infants and small children admitted to the pediatric emergency department (PED) with acute wheezing episodes (AWE) are currently treated with nebulized wet aerosol (NWA). OBJECTIVE: To determine the efficacy of MDI with Nebuchamber (Astra AB; Lund, Sweden), a nonelectrostatic spacer device (NESD), as compared to NWA in the treatment of an unselected population of babies and small children with AWE. DESIGN: Randomized, double-blind, placebo-controlled trial. Forty-two children referred to the PED (median age +/- SD, 16 +/- 15 months) with AWE received either placebo MDI through a NESD (four puffs) and salbutamol 0.5 mL (2.5 mg) as a NWA (group I, n = 19), or salbutamol MDI and 0.5 mL of saline solution administered in the same manner as above (group II, n = 23). This treatment was repeated three times every 20 min. RESULTS: The respiratory rates (RRs) at baseline were as follows: group I, 45 +/- 11.2 breaths/min; and group II, 52.3 +/- 11.3 breaths/min (p = not significant [NS]). After the first, second, and third interventions, the percent fall from baseline of the RR were as follows: group I, 8.9, 13.1, and 17.9%, respectively; group II, 8. 6, 14.6, and 18.6%, respectively. There was no significant difference at any time in the results between the two groups. The clinical scores (CSs) at baseline were as follows: group I, 6.6 +/- 1.3; group II, 6.8 +/- 1.49 (p = NS). After the first, second, and third interventions, the percent fall from baseline of the CS were as follows: group I, 9.1, 17.9, and 23.2%, respectively; group II, 8. 6, 18.9, and 24.7%, respectively. These results, also, did not differ significantly at any time between the two groups. Hospitalization rate and side effects did not differ between the two groups. CONCLUSIONS: We conclude that even in the group of unselected very young children (mean age < 2 years) with AWE, the use of MDI with NESD is at least as effective as the use of NWA. As opposed to data from an adult population, no plateau was reached in the dose-response curve using the above doses over time.

PMID

10807815 [PubMed - indexed for MEDLINE]

Tipo di studio

Randomizzato in doppio cieco

Livello di efficacia

1+

Commento

Titolo del documento

High-dose albuterol by metered-dose inhaler plus a spacer device versus nebulization in preschool children with recurrent wheezing: a double-blind equivalence trial

Autori e Nazionalità

Ploin D, Chapuis FR, Stamm D, Robert J, David L, Chatelain PG, Dutau G, Floret D. 

Fonte bibliografica

Pediatrics 2000; 106;311-7.

Lingua

Inglese

Abstract

Inhaled albuterol is the most frequently used bronchodilator for acute wheezing, and nebulization is the standard mode of delivery in hospital setting. However, recent guidelines consider spacer devices as an easier to use, and cost-saving alternative and recommend the high-dose metered-dose inhaler bronchodilator. OBJECTIVE: To demonstrate clinical equivalence between a spacer device and a nebulizer for albuterol administration. DESIGN: Randomized, double-blind, parallel group equivalence trial. SETTING: Pediatric emergency wards at 2 tertiary teaching hospitals. PATIENTS: Sixty-four 12- to 60-month-old children with acute recurrent wheezing (32 per group). INTERVENTIONS: Albuterol was administered through the spacer device (50 microg/kg) or through the nebulizer (150 microg/kg) and repeated 3 times at 20-minute intervals. Parents completed a questionnaire. OUTCOME MEASURES: Pulmonary index, hospitalization, ease of use, acceptability, and pulse oximetry saturation. RESULTS: The 90% confidence interval of the difference between treatment groups for the median absolute changes in pulmonary index values between T0 and T60 was [-1; +1] and was included in the equivalence interval [-1.5; +1.5]. Clinical improvement increased with time. Less than 10% of the children (3 in each group) required hospitalization (2 in each group attributable to treatment failure). Parents considered administration of albuterol using the spacer device easier (94%) and better accepted by their children (62%). CONCLUSIONS: The efficacy of albuterol administered using the spacer device was equivalent to that of the nebulizer. Given its high tolerance, repeated 50-microg/kg doses of albuterol administered through the spacer device should be considered in hospital emergency departments as first-line therapy for wheezing.

PMID

10920157 [PubMed - indexed for MEDLINE]

Tipo di studio

Randomizzato in doppio cieco

Livello di evidenza

1+

Commento

Spray con il distanziatore vs nebulizzatore per somministrare i broncodilatatori nella terapia dell'attacco acuto d'asma.

Titolo del documento

Future options for aerosol delivery to children

Autori e Nazionalità

Bisgaard H. Danimarca

Fonte bibliografica

Allergy 1999;54 Suppl 49:97-103

Lingua

Inglese

Abstract

There is an increasing awareness of the importance of reliable aerosol delivery, with emphasis on the dose delivered to the lungs, optimal clinical control, cost-effectiveness, and safety in children. Dose prescription should relate to the expected lung dose rather than the factory-dispensed dose, as at present. The device determines the lung dose. Clearly, therefore, the device should be considered an integral part of the prescription. Drug approval processes should clearly specify the device, and discourage the use of other devices. This would rationalize the choice of devices. Important new insights into factors essential for drug delivery to the airways have been acquired in recent years. Nasal inhalation increases systemic bioavailability, reduces lung dose, and adds to its variability; hence, face masks to prevent nasal breathing have been developed. Similarly, dead space in the inspiratory line causes a proportional reduction in lung dose; hence, attention should be paid to reducing such dead space. Plastics in spacers cause a rapid loss of drug due to electrostatic attraction of the aerosol. The residence time of the aerosol, i.e., the time available for inhalation, is increased in nonelectrostatic spacers, allowing less compliant children enough time to obtain a full dose. Eliminating the electrostatic charge can change the lung dose by several times; hence, nonelectrostatic materials should be used in future spacer devices. Compliance is the biggest problem in drug delivery to children. The inhaler design process should be reversed, adapting technology to the child. Interactive microchip technology should provide intelligent devices that react to correct handling and breathing maneuvers. An intelligent nebulizer has been developed that adapts nebulization to the child's breathing pattern, nebulizing only during inhalation and avoiding loss of aerosol during exhalation. An automatic device (AirPac) has been developed that transforms a dry-powder inhaler, Turbuhaler, into a spacer. In addition to the general advantages of spacer treatment, this device offers the advantage of a drug aerosol delivered without use of propellants or additives. The mechanical actuation ensures highly repeatable drug delivery. Finally, a nonelectrostatic, tower-shaped spacer provides a stable aerosol, which remains airborne for a prolonged period. The spacer is equipped with a face mask that prevents nasal breathing. Such features should improve our ability to treat young children with inhaled drug aerosols.

PMID

10422756 [PubMed - indexed for MEDLINE]

Tipo di studio

Revisione narrativa

Livello di evidenza

4

Commento

L'autore passa in rassegna le nuove tecnologie adottate per favorire la deposizione aerosolica nel paziente. Un po' datato.

Titolo del documento

Efficacy and safety of a home-made non valved-spacer for bronchodilator therapy in acute asthma.

Autori e Nazionalità

Duarte M, Camargos P. Brasile 

Fonte bibliografica

Acta Paediatr 2002;91:909-13.

Lingua

Inglese

Abstract

The aim of this study was to assess the efficacy and safety of an alternative spacer to deliver salbutamol in acute asthma. A prospective randomized study was performed with 196 patients with acute asthma, aged 4-15 y. The clinical features, oxygen saturation (SaO2) and the best of three peak expiratory flow rate (PEFR) measurements were recorded in a standardized questionnaire. Each patient received up to three conventional doses of salbutamol through an alternative home-made non-valved spacer (NVS) (500 ml mineral water plastic bottle) or an oxygen-driven nebulizer (ODN). The clinical and functional respiratory parameters (PEFR and SaO2) were assessed 15 min after each administration of the bronchodilator. In the ODN (n = 99) and NVS (n = 97) groups, PEFR (p > 0.05) and SaO2 (p > 0.05) measurements improved in all stages of the treatment. During the asthma attacks, the ODN group needed a prolonged observation in the emergency room (p = 0.000000). Side effects of salbutamol, e.g. increased heart rate, were observed in 17.2% of the patients in the ODN group and 4.1% in the NVS group (p = 0.003). CONCLUSION: Both devices showed comparable efficacy in mild and moderate acute attacks, but the use of the alternative NVS resulted in a shorter observation period in the emergency room. The frequency of side effects was significantly higher in the ODN group than in the NVS group.

PMID

12412864 [PubMed - indexed for MEDLINE]

Tipo di studio

Randomizzato

Livello di evidenza

1+

Commento

Spray con una bottiglia di plastica fatta in casa o ampolla attaccata alla presa di ossigeno per somministrare i broncodilatatori nell'attacco acuto d'asma.

Titolo del documento

Comparison of albuterol delivered by a metered dose inhaler with spacer versus a nebulizer in children with mild acute asthma.

Autori e Nazionalità

Schuh S, Johnson DW, Stephens D, Callahan S, Winders P, Canny GJ. Canada

Fonte bibliografica

J Pediatr 1999;135:22-27

Lingua

Inglese

Abstract

OBJECTIVE: In children with mild acute asthma, to compare treatment with a single dose of albuterol delivered by a metered dose inhaler (MDI) with a spacer in either a weight-adjusted high dose or a standard low-dose regimen with delivery by a nebulizer. STUDY DESIGN: In this randomized double-blind trial set in an emergency department, 90 children between 5 and 17 years of age with a baseline forced expiratory volume in 1 second (FEV1 ) between 50% and 79% of predicted value were treated with a single dose of albuterol, either 6 to 10 puffs (n = 30) or 2 puffs (n = 30) with an MDI with spacer or 0.15 mg/kg with a nebulizer (n = 30). RESULTS: No significant differences were seen between treatment groups in the degree of improvement in percent predicted FEV1 (P =.12), clinical score, respiratory rate, or O2 saturation. However, the nebulizer group had a significantly greater change in heart rate (P =.0001). Our study had 93% power to detect a mean difference in percent predicted FEV1 of 8 between the treatment groups. CONCLUSION: In children with mild acute asthma, treatment with 2 puffs of albuterol by an MDI with spacer is just as clinically beneficial as treatment with higher doses delivered by an MDI or by a nebulizer.

PMID

10393599 [PubMed - indexed for MEDLINE]

Tipo di studio

Randomizzato, in doppio cieco

Livello di evidenza

1+

Commento

Uno dei tanti studi di confronto distanziatori versus nebulizzatori per somministare i broncodilatatori. Qui vengono confrontati due dosaggi di salbutamolo spray: 2 puff e 6-10 puff

Titolo del documento

Home-made spacers for bronchodialator therapy in children with acute asthma: a randomised trial

Autori e Nazionalità

Zar HJ, Brown G, Donson H, Brathwalte N, Mann MD, Weinberg EG. Sud Africa

Fonte bibliografica

Lancet 1999;354(9183):979-82 

Lingua

Inglese

Abstract

BACKGROUND: A metered-dose inhaler (MDI) with spacer is the best way to deliver bronchodilator therapy for treatment of acute asthma. In developing countries, commercially produced spacers are generally unavailable or too costly. We tested the efficacy of home-made spacers (500 mL plastic bottle, polystyrene cup) compared with a conventional spacer for delivery of a beta2 agonist via MDI for children with acute asthma. METHODS: We studied children aged 5 to 13 years with acute asthma, stratified into those with mild airways obstruction (peak expiratory flow [PEF] 60-79% of predicted value) or moderate to severe airways obstruction (PEF 20-59% of predicted value). A beta2 agonist (fenoterol hydrobromide) was given via MDI and one of four randomly assigned spacers (conventional spacer, sealed 500 mL plastic bottle, unsealed 500 mL bottle, 200 mL polystyrene cup). Clinical score, pulmonary function tests, and oximetry were recorded at baseline and 15 min after treatment. If a second bronchodilator treatment was needed, nebulised fenoterol was given and the assessment repeated 15 min later. Primary outcome measures were changes in clinical score and pulmonary function, and need for and response to nebulisation. FINDINGS: 88 children were eligible for study. In 44 children with moderate to severe airways obstruction, a cup gave significantly less bronchodilation (median increase in: forced expiratory volume in 1 s [FEV1] 0%; PEF 12%) compared with the conventional spacer (37%; 59%), sealed bottle (33%; 36%), or unsealed bottle (18%; 21%, p<0.05 for difference between groups). Nebulisation was required by ten of 11 who had used a cup, nine of 11 who had used an unsealed bottle, eight of 11 who had used a sealed bottle, and only four of 11 who had used a conventional spacer. After nebulisation, improvement in FEV1 (15.5%) and PEF (26%) was more marked in children who had used a cup than in those who had used a conventional spacer (5.5% FEV1; 4% PEF), sealed bottle (3%; 0%), or unsealed bottle (7%; 9%). For 44 children with mild airways obstruction, response to bronchodilator was similar for all spacers and need for nebulisation was not associated with use of a particular spacer. INTERPRETATION: A conventional spacer and sealed 500 mL plastic bottle produced similar bronchodilation, an unsealed bottle gave intermediate improvement in lung function, and a polystyrene cup was least effective as a spacer for children with moderate to severe airways obstruction. Use of bottle spacers should be incorporated into guidelines for asthma management in developing countries.

 

PMID

10501359 [PubMed - indexed for MEDLINE]

Tipo di studio

Randomizzato

Livello di evidenza

1+

Commento

Ilprimo SCR eseguito da Zar che dimostra l'uguaglianza di efficacia nel somministare i broncodilatatori con una bottiglia di plastica delle bibite o con un distanziatore del commercio nell'attacco acuto d'asma 

Titolo del documento

A randomised contolled trial to assess the relative benefits of large volume spacers and nebulisers to treat acute asthma in hospital

Autori e Nazionalità

Dewar AL, Stewart A, Cogswell JJ, Connett GJ. Gran Bretagna

Fonte bibliografica

Arch Dis Child 1999;80:421-23

Lingua

Inglese

Abstract

OBJECTIVES: To compare the clinical effectiveness, acceptability, and cost benefit of administering beta2 agonists by means of a metered dose inhaler and large volume spacer with conventional nebulisers to children admitted to hospital with acute asthma. METHODS: A randomised controlled trial was conducted over five months. Sixty one children older than 3 years admitted to a large teaching hospital and a district general hospital with acute asthma completed the study. Children received either 5 mg of salbutamol up to one hourly by jet nebuliser, or up to 10 puffs of salbutamol 100 microg by means of a metered dose inhaler and spacer up to one hourly. RESULTS: Median hospital stay was 40 hours in the nebuliser group and 36.5 hours in the spacer group. Asthma disability scores at two weeks after discharge were significantly improved in the spacer group. Drug costs were pound 14.62 less for each patient in the spacer group. CONCLUSIONS: Large volume spacers are an acceptable, cost effective alternative to nebulisers in treating children admitted with acute asthma, provided that the children can use the mouthpiece, and symptoms are not severe. Their use facilitates effective home treatment by parents, with subsequent reduction in morbidity and re-admission rates.

PMID

10208945 [PubMed - indexed for MEDLINE]

Tipo di studio

Randomizzato

Livello di evidenza

1+

Commento

Uno degli studi di confronto distanziatori vs nebulizzatori per somministrare i broncodilatatori nell'attacco acuto d'asma, incluso nella Revisione Sistematica della Cochrane di Cates

Titolo del documento

Efficacy of bronchodilators administered by nebulizers versus spacer devices in infants with acute wheezing 

Autori e Nazionalità

Closa RM, Ceballos JM,Gomez-Papi A, Galiana AS, Gutierrez C, Marti-Henneber C. Spagna

Fonte bibliografica

Pediatr Pulmonol 1998;26:344-348

Lingua

Inglese

Abstract

The aim of this study was to compare the response of infants with acute wheezing to treatments with inhaled terbutaline when administered by nebulizer or by metered-dose inhaler and spacer device (MDI-spacer). Thirty-four infants between the ages of 1 and 24 months who were seen in our emergency department for acute wheezing were studied in a double-blind, randomized trial. The participants received two treatments of terbutaline at 20-min intervals, either by a nebulizer (2 mg/dose in 2.8 mL of 0.9% saline solution) or by an MDI-spacer device (0.5 mg/dose). The outcome measure was a clinical score, based on respiratory rate, degree of wheezing, retractions, degree of cyanosis, color, and pulse oximetry data measured before treatment, 20 min after the first treatment, and again 20 min after the second treatment. There was no difference in the rate of improvement in the clinical score between infants who received terbutaline by nebulizer and those who received it by MDI-spacer. We conclude that MDI-spacers and nebulizers are equally effective means of delivering beta-2 agonists to infants and small children with acute wheezing.

PMID

9859904 [PubMed - indexed for MEDLINE]

Tipo di studio

Randomizzato in doppio cieco

Livello di evidenza

1+

Commento

testo

Titolo del documento

Comparative efficacy of jet nebulizer and metered dose inhaler with spacer device in the treatment of acute asthma.

Autori e Nazionalità

Batra V, Sethi GR, Sachdev HP. India

Fonte bibliografica

Indian Pediatr 1997;34:497-503.

Lingua

Inglese

Abstract

OBJECTIVE: To compare the relative efficacy of jet nebulizer and metered dose inhaler (MDI) with spacer for the administration of aerosolized salbutamol in an acute exacerbation of bronchial asthma. DESIGN: Randomized prospective study. SETTING: Emergency Room. METHODS: In 60 subjects with acute asthma aged between 1 to 12 years, clinical and laboratory assessment of severity at recruitment included heart rate, respiratory rate, pulsus paradoxus, arterial blood gas analysis (all cases) and peak expiratory flow rate (wherever possible). The subjects were randomized into two equal groups to receive aerosolized salbutamol either via nebulizer (Group I) or MDI-spacer (Group II) as per the Consensus Guidelines. The response to therapy was sequentially assessed after 20, 40 and 60 minutes of institution of therapy. RESULTS: A significantly (p < 0.02) greater number of subjects in Group II presented with severe dyspnea and intercostal muscle retraction (subjective assessment). However, the objectively evaluable outcome parameters were comparable (p > 0.05) in both groups at presentation. All the outcome measures showed a significant (p < 0.05) improvement with time in both the groups. The recovery parameters were comparable (p > 0.05) at different time periods in the two groups. CONCLUSION: MDI-spacer is as effective as a nebulizer for the aerosolized administration of salbutamol in an acute exacerbation of asthma in children. However, for developing countries, distinct advantages (economic and power requirement) argue strongly for utilization of MDI-spacer in preference to nebulizer.

PMID

9357205 [PubMed - indexed for MEDLINE]

Tipo di studio

Randomizzato 

Livello di evidenza

1+

Commento

Incluso nella Revisione Sistematica della Cochrane di confronto distanziatori vs nebulizzatori per somministrare i broncodilatatori nell'asma acuto

Titolo del documento

Inhalers and nebulizers: which to choose and why. Respir Med 1996;90:69-77

Autori e Nazionalità

Pedersen S 

Fonte bibliografica

Respir Med 1996;90:69-77

Lingua

Inglese

Abstract

It is obvious that many factors should be considered when an inhaler is prescribed. Based upon the information discussed above, a rational inhaler strategy could be as follows: (1) Children < or = 5 years and elderly patients are prescribed a spacer with a valve system (and a face mask for the children) for the delivery of all drugs. When they are severely obstructed, some may need a nebulizer. If the patient cannot be taught the correct use of a spacer, a nebulizer should be prescribed. (2) Children > or = 5 years and adults are prescribed a spacer or a Turbuhaler for the administration of inhaled corticosteroids and a dry powder inhaler (preferably multiple dose) or a breath-actuated MDI for other drugs. If these alternatives are not available or the patient prefers, a conventional MDI can be used (preferably not for other corticosteroids than fluticasone propionate) provided that careful tuition is given. Fluticasone dipropionate may be given by DPI, Spacer or MDI. (3) Nebulizers are mainly reserved for severe acute attacks of bronchoconstriction. With this approach, most patients can be taught effective inhaler use with a minimum of instructional time. Finally, it must always be remembered to consider the patient's wish, since prescription of an inhaler which the physician likes but the patient does not is likely to reduce compliance.

PMID

8730324 [PubMed - indexed for MEDLINE]

Tipo di studio

Revisione narrativa

Livello di evidenza

4

Commento

Una sintesi delle conoscenze (di 11 anni fa) sulla tecnica inalatoria relativa ai principali device ( MDI, spacer, polveri secche)

Titolo del documento

Metered-dose inhalers with spacers vs nebulizers for pediatric asthma.

Autori e Nazionalità

Chou KJ, Cunningham SJ, Crain EF. Usa

Fonte bibliografica

Arch Pediatr Adolesc Med 1995;149:201-205

Lingua

Inglese

Abstract

OBJECTIVE: To determine whether the administration of beta-agonists by metered-dose inhaler (MDI) with a spacer device is as effective as the administration of beta-agonists by nebulizer for the treatment of acute asthma exacerbations in children. DESIGN: Randomized trial with two arms. SETTING: Urban pediatric emergency department (ED) in Bronx, NY. PATIENTS: Convenience sample of 152 children 2 years and older with a history of at least two episodes of wheezing presenting to the ED with an acute asthma exacerbation. INTERVENTIONS: Patients were randomly assigned to receive standard doses of a beta-agonist (albuterol) by an MDI with spacer or by a nebulizer. Dosing intervals and the use of other medications were determined by the treating physician. MEASUREMENTS/MAIN RESULTS: Baseline characteristics and asthma history were recorded. Asthma severity score, peak expiratory flow rate in children 5 years or older, and oxygen saturation were determined at presentation and before admission or discharge. The groups did not differ in age, sex, ethnicity, age of onset of asthma, or asthma severity score at presentation. There were no significant differences between the groups in outcomes, including mean changes in respiratory rate, asthma severity score, and peak expiratory flow rate, oxygen saturation, number of treatments given, administration of steroids in the ED, and admission rate. Patients given MDIs with spacers required shorter treatment times in the ED (66 minutes vs 103 minutes, P < .001). Fewer patients in the spacer group had episodes of vomiting in the ED (9% vs 20%, P < .04), and patients in the nebulizer group had a significantly greater mean percent increase in heart rate from baseline to final disposition (15% vs 5%, P < .001). CONCLUSIONS: These data suggest that MDIs with spacers may be an effective alternative to nebulizers for the treatment of children with acute asthma exacerbations in the ED.

PMID

7849885 [PubMed - indexed for MEDLINE]

Tipo di studio

Randomizzato

Livello di evidenza

1+

Commento

Spray con distanziatore vs nebulizzatore per somministrare i broncodilatatori nell'attacco acuto d'asma. 

Titolo del documento

Metered dose inhaler and nebuliser in acute asthma

Autori e Nazionalità

Lin YZ, Hsieh KH. Taiwan. 

Fonte bibliografica

Arch Dis Child 1995;72:214-8. 

Lingua

Inglese

Abstract

One hundred and eleven children with acute asthma were studied to compare delivery of terbutaline by either a metered dose inhaler (MDI) with a valved holding chamber or a nebuliser driven by air. Eligible patients were randomised; the MDI group received three puffs (0.75 mg) of terbutaline and the nebuliser group received 2 ml (5.0 mg) terbutaline solution diluted with 2 ml 0.9% saline for inhalation over 10 minutes. Patients were evaluated by spirometry, pulse oximetry, and clinical severity scoring system at baseline and again 15 minutes after the beginning of treatment. The baseline data of the two groups were not significantly different. All parameters of spirometry, except the peak expiratory flow (PEF) for the nebuliser group, and clinical severity score for both groups significantly improved after terbutaline treatment. Compared with the nebuliser group, the MDI group after treatment had better mean (SD) oxygen saturation (SaO2; 96.82 (1.63)% v 95.44 (1.88)%), frequency of oxygen desaturation (23.2% v 47.3%), absolute increase of PEF (32.6 (37.7) l/min v 10.2 (34.7) l/min), and SaO2 (0.54 (1.64)% v -0.47 (1.84)%). There was also a mean (SD) per cent increase of forced expiratory volume in one second (22.9 (21.0)% v 15.4 (16.1)%), PEF (27.7 (38.4)%) v 7.7 (25.1)%), and SaO2 (0.58 (1.72)% v -0.47 (1.93)%). In conclusion, aerosol treatment by MDI (with a valved holding chamber) in this study proved to be superior to nebuliser treatment in terms of SaO2 and some measurements of spirometry. Respiratory therapists working with children with severe asthma should be aware of the possibility of oxygen desaturation, especially when using room air as the driving gas for nebulisation.

PMID

7741566 [PubMed - indexed for MEDLINE]

Tipo di studio

Randomizzato

Livello di evidenza

1+

Commento

Spray con il distanziatore vs nebulizzatore per somministrare i broncodilatatori nell'attacco acuto d'asma.

Titolo del documento

Randomised trial spacer v nebuliser for acute asthma.

Autori e Nazionalità

Parkins PC, Saunders NR, Diamond SA, Winders PM, Macarthur C. Canada

Fonte bibliografica

Arch Dis Child 1995;72:239-240

Lingua

Inglese

Abstract

Sixty hospitalised children with asthma aged 1-5 years were randomised to spacer or nebuliser. A clinical score was measured at baseline and every 12 hours. There were no differences between groups in the score over time, or secondary outcome measures. The spacer is an effective delivery method for young hospitalised asthmatic children.

PMID

7741574 [PubMed - indexed for MEDLINE]

Tipo di studio

Randomizzato

Livello di evidenza

1+

Commento

Spray con il distanziatore vs nebulizzatore per somministrare i broncodilatatori nella terapia dell'attacco acuto d'asma.

Titolo del documento

Babyhaler-a new paediatric aerosol device.  

Autori e Nazionalità

Kraemer R. Svizzera

Fonte bibliografica

J Aerosol Med 1995;8 Suppl 2;S19-26.

Lingua

Inglese

Abstract

Nebulizers have, until recently, been the mainstay of drug delivery by inhalation in babies and young children. The willingness of a young child to cooperate, however, is limited and the 10-12 mins needed to deliver drug using a nebulizer often limits the compliance with this mode of administration in infants. Therefore, drug delivery systems using the metered-dose inhaler (MDI) as the aerosol generator attached to valved holding chambers were developed. The breathing pattern of a baby with lung disease is quite different from that of older children and adults, for whom most large-volume devices were developed. Infants have a high respiratory frequency, small tidal volume, and low inspiratory airflow rate. Therefore, specific conditions for optimal drug use in this particular group of patients have to be met. Efficacy of topical drug delivery depends on the generation of aerosol particles with an adequate size distribution (technical prerequisites), the breathing pattern of the child (physiological requirements), and the willingness of a young child to cooperate with parental drug administration (practicality and compliance). Infants with lung disease have a tidal volume of 8-10ml/kg body weight. The volume of a spacer device must be such that about 5-10 breaths would be needed to provide an adequate dose. In addition, the dimensions of a spacer device must be such that sufficient drug particles of optimal size will be generated to minimize impaction and deposition within the device. The Babyhaler consists of a tubular chamber 230mm long, with a volume of 350ml and low-resistance inspiratory and expiratory valves

PMID

10155355 [PubMed - indexed for MEDLINE]

Tipo di studio

Revisione narrativa

Livello di evidenza

4

Commento

Le caratteristiche del Babyhaler

Titolo del documento

Efficacy of albuterol administered by nebulizer versus spacer device in children with acute asthma 

Autori e Nazionalità

Kerem E, Levison H, Schuh s, O'Brodovich H, Reisman J, Bentur L, Canny GJ

Fonte bibliografica

J Pediatr

Lingua

Inglese

Abstract

The aim of this study was to compare the response to inhaled albuterol after administration by nebulizer with the response after administration by a metered-dose inhaler and spacer device (MDI-spacer) to children with acute asthma. In a double-blind fashion, 33 children (6 to 14 years of age) with forced expiratory volume in 1 second (FEV1) between 20% and 70% of predicted values, and who were seen in the emergency department with acute asthma, were studied. They were treated with aerosolized albuterol or placebo by MDI-spacer, followed immediately by albuterol or placebo administered by nebulizer with oxygen. The dose ratio for albuterol by MDI-spacer versus nebulizer was 1:5. Outcome measures included a clinical score, respiratory rate, arterial oxygen saturation, and FEV1, measured before and 10, 20, and 40 minutes after treatment. With the exception of heart rate (which increased in the nebulizer group and decreased in the MDI-spacer group (p < 0.05), no difference in the rate of improvement of clinical score, respiratory rate, arterial oxygen saturation, or FEV1 was noted during the 40-minute study period between children who received albuterol by nebulizer and those who received it by MDI-spacer. We conclude that spacers and nebulizers are equally effective means of delivering beta 2-agonists to children with acute asthma.

PMID

8345434 [PubMed - indexed for MEDLINE]

Tipo di studio

Randomizzato, in doppio cieco

Livello di evidenza

1+

Commento

Spray con il distanziatore vs nebulizzatore per somministrare i broncodilatatori nell'attacco acuto d'asma

Titolo del documento

Comparative efficacy of terbutaline administered by Nebuhaler and by nebulizer in young children with asthma.

Autori e Nazionalità

Pendergast J, Hopkins J, Timms B, Van Asperen PP. Australia.

Fonte bibliografica

Med J Aust 1989;151:406-8. Australia 

Lingua

Inglese

Abstract

We compared the use of terbutaline sulphate that was delivered by a nebulizer with its delivery by a Nebuhaler at two dose levels in 27 children (nine children per group) of between three and six years of age with acute asthma. No significant difference was found in the mean baseline clinical score among the three groups, and a significant decline occurred in the mean clinical scores in all groups by 15 minutes which was maintained to 60 minutes after the dose was administered. The decline that was achieved with delivery of the drug by way of a Nebuhaler (at either dose level) was not significantly different from that with a nebulizer, although cooperation with Nebuhaler usage was not universal in the age-group.

PMID

2677624 [PubMed - indexed for MEDLINE]

Tipo di studio

Randomizzato

Livello di evidenza

1+

Commento

Spray con il distanziatore vs nebulizzatore  per somministrare i broncodilatatori nella terapia dell'attacco acuto d'asma.

Titolo del documento

Wet nebulizer versus spacer and metered dose inhaler via tidal breathing

Autori e Nazionalità

Ba M, Spier S, Lapierre G, Lamarre A. Ghana 

Fonte bibliografica

J Asthma 1989;26:355-8

Lingua

Inglese

Abstract

testo

PMID

2702242 [PubMed - indexed for MEDLINE]

Tipo di studio

Randomizzato

Livello di evidenza

1+

Commento

Spray con il distanziatore versus nebulizzatore per somministrare i broncodilatatori nell'attacco acuto d'asma

Titolo del documento

Nebuhaler versus nebulizer in children with acute asthma.

Autori e Nazionalità

Freelander M, Van Asperen PP

Fonte bibliografica

Br Med J 1984;288:1873-4. Australia

Lingua

Inglese

Abstract

testo

PMID

6428582 [PubMed - indexed for MEDLINE]

Tipo di studio

Randomizzato

Livello di evidenza

1+

Commento

Spray con il distanziatore vs nebulizzatore per somministrare i broncodilatatori nell'attacco acuto d'asma.