Advances in inhalation therapy in pediatrics

Abstract

Objectives: To review the most relevant articles regarding the technical aspects of inhalation therapy, inhalers currently available, and especially major advances in inhalation therapy in pediatrics. Sources:Articles of MEDLINE database from 1983 were reviewed, in addition to book chapters, and the most important studies were selected according to the criteria established for this article. Summary of the findings:Conventional nebulizers have a number of inconveniences, and breath-enhanced and breath-actuated inhalers are more attractive options. Among dry powder inhalers, we highlight those using passive and active powder dispersion mechanisms, which provide higher rates of drug deposition in the lung. Among pressurized metered-dose inhalers, we highlight breath-actuated, breath-coordinated, and velocity-modifying inhalers. These inhalers should be used preferably together with spacers, since the use of spacers produces a twofold increase in pulmonary drug deposition. Conclusions:For children younger than 8 years, pressurized metereddose inhalers with spacers are the most appropriate devices, since they provide a practical approach associated with greater lung deposition. In children older than 8 years who can generate high inspiratory flow rates, dry powder devices are best suited. J Pediatr (Rio J). 2010;86(5):367-376:Nebulizers, pressurized metered-dose inhalers, dry powder inhalers, spacers, pulmonary drug deposition. ResumoObjetivos: Revisar os artigos mais relevantes a respeito dos aspectos técnicos da terapêutica inalatória, dos inaladores disponíveis e principalmente dos principais avanços obtidos na inaloterapia em pediatria. Fontes dos dados:Foram revisados os artigos contidos na base de dados MEDLINE a partir de 1983, além de capítulos de livros, e selecionados os de maior importância de acordo com os critérios estabelecidos para este artigo. Síntese dos dados:Os nebulizadores convencionais apresentam uma série de inconveniências, sendo que inaladores com desempenho melhorado pela respiração e os ativados pela respiração são opções mais atrativas. Dentre os inaladores de pó seco, destacam-se os que utilizam mecanismos passivos e ativos de dispersão de pó, que propiciam maiores taxas de deposição pulmonar das drogas. Entre os inaladores pressurizados dosimetrados destacam-se os ativados pela respiração, os coordenados pela respiração e os modificadores de velocidade. Devem ser usados preferencialmente em conjunto com espaçadores, pois a utilização deste aumenta em até duas vezes a deposição pulmonar das drogas.Conclusões: Para menores de 8 anos, os inaladores pressurizados dosimetrados com espaçadores são os mais adequados, dada a sua praticidade associada à elevada deposição pulmonar que proporcionam. Nos maiores de 8 anos capazes de gerar altos fluxos inspiratórios, os dispositivos de pó são os mais indicados.J Pediatr (Rio J). 2010;86(5):367-376: Nebulizadores, inaladores pressurizados dosimetrados, inaladores de pó seco, espaçadores, deposição pulmonar de drogas. Advances in inhalation the...

Advancements in Dry Powder Inhaler

“…Novolizer is a multidose DPI from MEDA. In this inhaler, a cyclone is generated in the mouthpiece through multiple supply channels during inhalation [5,11]. Newman et al (2000) reported that Novolizer ® showed a higher deposition of budesonide in the lung and lower oropharyngeal deposition when compared to Turbuhaler ® [13].…”

“…The process of particle de-agglomeration can be carried out by developing technologies that use energy as key factor in DPI. Storage of energy in systems based on springs, compressed air or battery powered chambers were some of the alternatives found in inhalers [11].…”

“…This inhaler is hence helpful in the treatment of critically ill patients, elderly or children. The patient using Spiros inhaler uses less than one-quarter of dispersion energy as compared to Turbuhaler and also there is increased fine particle fraction [5,11].…”

“…Similar porous particles may be coupled to long-sized carrier molecules to reach the lungs with similar efficacy [11,19]. Formulation having aerodynamic diameter in range of 1-3 μm results in lower tendency to aggregate, which when combined with lower density particles leads to aerosolization efficiently.…”

“…Inhaled insulin delivery by powder devices may provide a considerable benefit in quality of life for a large number of patients [11]. Several companies as listed in Table 1 have worked to develop inhaled insulin systems for diabetic patients over the last two decades.…”