Aerosol Therapy by Pressured Metered-Dose Inhaler-Spacer in Sleeping Young Children

Esposito-Festen, J.E.; IJsselstijn, Hanneke; Hop, Wim C. J.; Vliet, Frans van; Jongste, Johan C. de; Tiddens, Harm A.W.M.

doi:10.1378/chest.130.2.487

Cited by 22 publications

(13 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Not surprisingly, the delivered dose in this study was only about half of that in awake, cooperative infants 2. Based on these disappointing studies, a recent Canadian guideline discourages parents from attempting to deliver aerosols to their infants during sleep 3…”

Section: Discussionmentioning

confidence: 72%

“…A previous real-life study using a pressurised metered dose inhaler (pMDI) with a valved aerosol holding chamber (VHC) in young children2 provided disappointing results; 69% of the children awoke during aerosol administration, and there was poor compliance and negligible benefit. No similar study followed this failure and a recent Canadian report discourages parents from this practice 3…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Feasibility of aerosol drug delivery to sleeping infants: a prospective observational study

Amirav

Newhouse²,

Luder

et al. 2014

BMJ Open

View full text Add to dashboard Cite

ObjectivesDelivery of inhaled medications to infants is usually very demanding and is often associated with crying and mask rejection. It has been suggested that aerosol administration during sleep may be an attractive alternative. Previous studies in sleeping children were disappointing as most of the children awoke and rejected the treatment. The SootherMask (SM) is a new, gentle and innovative approach for delivering inhaled medication to infants and toddlers. The present pilot study describes the feasibility of administering inhaled medications during sleep using the SM.DesignProspective observational study.SettingOut patients.Participants13 sleeping infants with recurrent wheezing who regularly used pacifiers and were <12 months old.InterventionParticipants inhaled technetium99mDTPA-labelled normal saline aerosol delivered via a Respimat Soft Mist Inhaler (SMI) (Boehringer-Ingelheim, Germany) and SM + InspiraChamber (IC; InspiRx Inc, New Jersey, USA).OutcomesThe two major outcomes were the acceptability of the treatment and the lung deposition (per cent of emitted dose).ResultsAll infants who fulfilled the inclusion criteria successfully received the SM treatment during sleep without difficulty. Mean lung deposition (±SD) averaged 1.6±0.5% in the right lung.ConclusionsThis study demonstrated that the combination of Respimat, IC and SM was able to administer aerosol therapy to all the sleeping infants who were regular pacifier users with good lung deposition. Administration of aerosols during sleep is advantageous since all the sleeping children accepted the mask and ensuing aerosol therapy under these conditions, in contrast to previous studies in which there was frequent mask rejection using currently available devices.Clinical Trial RegistryNCT01120938.

show abstract

Section: Discussionmentioning

confidence: 72%

Section: Introductionmentioning

confidence: 99%

Feasibility of aerosol drug delivery to sleeping infants: a prospective observational study

Amirav

Newhouse²,

Luder

et al. 2014

BMJ Open

View full text Add to dashboard Cite

show abstract

“…Crying and lack of proper mask seal are known to decrease intrapulmonary deposition. 17,18,20 An in vivo study by Esposito-Festen et al 21 demonstrated lack of acceptability and efficiency of aerosol delivery during sleep in a group of toddlers. This study highlighted the importance of interface acceptance to achieve good drug delivery.…”

Section: Introductionmentioning

confidence: 99%

In Vitro Evaluation of Aerosols Delivered via the Nasal Route

Taoum

Kim

et al. 2015

Respir Care

View full text Add to dashboard Cite

BACKGROUND: Infants and young children are obligate nose breathers; therefore, a transnasal route seems the logical delivery method of inhaled aerosols. The efficiency of aerosol delivery depends on several factors, such as interface, type of nebulizer, and patient age and breathing pattern. We hypothesized that the use of a vibrating mesh nebulizer, a tight-fitting face mask, and a head model and breathing pattern of an older child would result in a higher lung dose. We also hypothesized that the use of an anatomically correct model would more accurately reflect lung dose than models that do not include airways. METHODS: A model comprising a breathing simulator and an anatomically correct model of a 7-month-old infant and a 5-y-old child with an interposed collection filter (lung dose) were used. Breathing patterns of a newborn, infant, and child were used with 7 interfaces. A continuous output and a vibrating mesh nebulizer were loaded with albuterol sulfate solution (5 mg/3.5 mL) and operated for 5 min. Albuterol mass was determined via spectrophotometer (276 nm). RESULTS: Lung dose varied between 0 and 3%. The jet nebulizer was more efficient than the vibrating mesh nebulizer. The front-loaded mask was the most efficient interface. We also found that higher tidal volumes were associated with higher lung doses and that the use of a larger airway model resulted in a lower lung dose. Finally, the model showed a good correlation with in vivo data and rendered lung doses severalfold lower than previous data obtained with oral models. CONCLUSIONS: Careful pairing of the aerosol generator and interface is very important during transnasal aerosol delivery.

show abstract

“…However, it should be noted that this technique will only work if the sleep is not compromised. Indeed, in vitro studies with a breathing simulator showed the potential for improved drug delivery to the lungs during sleep, but in vivo studies reported a high percentage of children waking up, which resulted in a half the drug deposition as compared to administration during an awake state [56]. To address this issue, administration during sleep can be made with a hood, thus avoiding contact with the child's face.…”

Section: A C C E P T E D Article In Pressmentioning

confidence: 99%

Inhaled corticosteroid therapy with nebulized beclometasone dipropionate

Nicolini

Cremonesi

Melani

2010

Pulmonary Pharmacology & Therapeutics

View full text Add to dashboard Cite

Inhaled corticosteroids (ICS) are the most effective anti-inflammatory agents for the management of chronic persistent asthma, and are therefore recommended as first-line antiasthmatic therapy in children and adults. In various settings, the administration of ICS via nebulizer rather than hand-held inhaler (HHI) may have certain advantages, as many patients with HHI fail to use these devices properly or efficiently. In particular, young children, the elderly, the acutely ill, and those with restricted dexterity may be unable to coordinate inhalation with actuation of the device or to generate sufficient inspiratory flow to operate breath-actuated devices effectively. Compliance with nebulized therapy may also be better than that with a pressurized metered-dose inhaler (pMDI) plus spacer. Systematic reviews conclude that there is no significant difference in clinical effects between nebulizers and HHI. Performance and clinical effect of nebulization are influenced by several technical aspects such as the nebulizer-drug combination, nebulizer type, output and lung deposition. Among the currently available ICS, nebulized beclometasone dipropionate (BDP) has been in clinical use for more than 35 years, and has demonstrated marked clinical efficacy and a favorable tolerability profile in children and adults with chronic persistent asthma. The clinical efficacy of nebulized beclometasone is discussed in the present review using data from 13 published studies, which included a total of 1250 patients. Three multicenter, randomized, double-blind studies showed that nebulized BDP is as effective as BDP via pMDI plus spacer in a 2:1 dose ratio. Controlled trials involving 497 adults and children demonstrated similar clinical efficacy between nebulized BDP and either nebulized fluticasone propionate or nebulized budesonide. In all these trials, treatment-related adverse effects were generally uncommon, most were mild to moderate in severity, and most were associated with the respiratory system. Metaanalyses show that BDP, like other inhaled corticosteroids, has no major influence on patient height, urinary cortisol concentration, or bone metabolism, thus suggesting the absence of growth retardation or any marked effect on adrenal function or the hypothalamic-pituitaryadrenal axis when used in the approved dose range. M A N U S C R I P T A C C E P T E D ARTICLE IN PRESSOverall, nebulized BDP appears to have a particularly important place in asthma therapy: as a general alternative to HHIs (e.g. in patients with poor HHI compliance); when patients such as children or the elderly are unable to operate HHIs because of poor hand-lung coordination, lack of cooperation, or low inspiratory flow rate; and when high dosages of ICS are required, such as in adults with severe, corticosteroid-dependent asthma.

show abstract

Aerosol Therapy by Pressured Metered-Dose Inhaler-Spacer in Sleeping Young Children

Cited by 22 publications

References 19 publications

Feasibility of aerosol drug delivery to sleeping infants: a prospective observational study

Feasibility of aerosol drug delivery to sleeping infants: a prospective observational study

In Vitro Evaluation of Aerosols Delivered via the Nasal Route

Inhaled corticosteroid therapy with nebulized beclometasone dipropionate

Contact Info

Product

Resources

About