Titolo del documento

Aerosol therapy by pressured metered-dose inhaler-spacer in young children: to do or not to do ?

Autori e Nazionalità

Esposito-Festen J, Ijsselstijin H, Hop W, van Vliet F, de Jongste J, Tiddens H.  Olanda

Fonte bibliografica

Chest 2006;130:487-92

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

Osservazionale

Livello di evidenza

2+

Commento

Somministare l'aerosol con lo spray e il distanziatore durante il sonno del bambino piccolo non offre alcun vantaggio e spesso non risulta possibile, perchè il lattante si sveglia

Titolo del documento

Aerosol therapy and the fighting toddler: is administration duering sleep an alternative ?

Autori e Nazionalità

Janssens H, van der Wiel EC, Verbraak AF, de Jongste JC, Merkus PJ, Tiddens HA. Olanda 

Fonte bibliografica

J Aerosol Med 2003;16:395-400. 

Lingua

Inglese

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.

PMID

14977430 [PubMed - indexed for MEDLINE]

Tipo di studio

Osservazionale

Livello di evidenza

3

Commento

Utilizzando un modello sperimentale gli autori sostengono che il sonno favorirebbe la deposizione polmonare del farmaco: questo risultato è stato però ottenuto in bambini sedati con cloralio idrato, realizzando un pattern ideale di sonno

Titolo del documento

Nebuliser hood compared to mask in wheezy infants: aerosol therapy without tears ! 

Autori e Nazionalità

Amirav I, Balanov I, Gorenberg M, Groshar D, Luder AS. Israele

Fonte bibliografica

Arch Dis Child 2003;88:719-723

Lingua

Inglese

Abstract

BACKGROUND: Small volume nebulisers (SVNs) with masks commonly provide aerosol therapy for infants with lung diseases. However, infants and toddlers are often disturbed by and thus reject masks. AIMS: To compare the lung deposition efficiency of the "usual" SVN aerosol mask and a prototype hood attached to an SVN. The advantage of the hood is that no mask is needed and medication can readily be administered during sleep. METHODS: 99mTc salbutamol solution was administered at random by SVN plus mask or hood to 14 wheezy infants (mean age 8 (SD 5) months). The dose and distribution of salbutamol were evaluated using gamma scintigraphy. Clinical response, tolerability by the infants, and parent preference were also compared. RESULTS: Mean total lung deposition was 2.6% with the hood and 2.4% with the mask (p > 0.05). Variability with the mask was greater than with the hood (coefficient of variation (CoV) 54% v 39%). Both treatments provided similar clinical benefit and side effects as reflected in improved oxygen saturation, reduced respiratory frequency, and increased heart rate. Infants accepted the hood better than the mask and there was a positive correlation between poor acceptance and upper airways and stomach deposition for both treatment modalities. Parents preferred the hood treatments. CONCLUSIONS: Aerosol therapy by hood is as efficient as by mask but provides a better therapeutic index. It is much better tolerated by infants and preferred by parents. Hood nebulisation is a simple and patient friendly mode of aerosol therapy in wheezy infants.

PMID

12876173 [PubMed - indexed for MEDLINE]

Tipo di studio

Randomizzato in aperto, cross over 

Livello di evidenza

1-

Commento

L'autore propone il trattamento aerosolico con salbutamolo effettuato attraverso una cappa (del tipo di quella usata nell'ossigenoterapia dei neonati): in questo modo si eviterebbe il pianto e gli effetti clinici sarebbero gli stessi. Il numero di pazienti arruolati è molto esiguo (n =14). Possibili i bias.