A path to successful patient outcomes through aerosol drug delivery to children: a narrative review

Abstract

Although using aerosolized medications is a mainstay of treatment in children with asthma and other respiratory diseases, there are many issues in terms of device and interface selection, delivery technique and dosing, as well as patient and parental education that have not changed for half a century. Also, due to many aerosol devices and interfaces available on the market and the broad range of patient characteristics and requirements, providing effective aerosol therapy to children becomes a challenge. While aerosol delivery devices are equally effective, if they are age-appropriate and used correctly, the majority of aerosol devices require multiple steps to be used efficiently. Unfortunately, many children with pulmonary diseases have problems with the correct delivery technique and do not gain therapeutic benefits from therapy that result in poor disease management and increased healthcare costs. Therefore, the purpose of this paper is to review the current knowledge on aerosol delivery devices used in children and guide clinicians on the optimum device-and interface-selection, delivery technique, and dosing in this patient population. Strategies on how to deliver aerosolized medications in crying and distressed children and how to educate parents on aerosol therapy and promote patient adherence to prescribed medications are also provided. Future directions of aerosol therapy in children should focus on these issues and implement policies and clinical practices that highlight the potential solutions to these problems.

Reconciling Oxygen and Aerosol Delivery with a Hood on In Vitro Infant and Paediatric Models

“…A facemask or hood is the recommended interface for aerosol therapies in children aged 1−3 years [11]. A facemask is commonly used as an interface for a nebuliser during aerosol therapy.…”

“…Children also showed greater tolerance and parents showed greater preference for treatment delivery using the hood. Therefore, the use of a hood has been proposed as a viable option for aerosol therapy in children [11].…”

Place of nebulizer therapy in the treatment of bronchial asthma in children

“…• Длительная ингаляция может привести к снижению комплаенса. Седиментация аэрозолей в желудочнокишечном тракте у плачущих детей на 50% выше, чем у спокойных пациентов [48].…”

Quantifying Delivered Dose with Jet and Mesh Nebulizers during Spontaneous Breathing, Noninvasive Ventilation, and Mechanical Ventilation in a Simulated Pediatric Lung Model with Exhaled Humidity

“…Since children are nose breathers, upper airways filter inhaled gas. While aerosol deposition in children is lower compared to adults due to these physiologic differences, the reduced lung dose is body mass appropriate, and the weight-corrected doses can be similar to an adult’s [ 1 , 3 , 4 ]. More research is warranted to determine the correct dose, especially in infants and children.…”

“…Since most aerosol devices require multiple steps for optimum use, the correct delivery of aerosol therapy poses problems for children [ 5 , 6 , 7 , 8 ]. According to previous research, poor hand strength, inadequate breath holding and inappropriate inspiratory flow may be an issue with pressurized metered dose inhalers (pMDIs) [ 4 ]. Because an optimal inspiratory flow rate is essential for the correct use of dry powder inhalers (DPI) [ 9 , 10 ], children who are in acute conditions or younger than 6 years of age may not have the physical or cognitive abilities to achieve the required DPI flow rate.…”