Current options in aerosolised drug therapy for children receiving respiratory support

Abstract

Inhalation of aerosolised medications are the mainstay of treatment for a number of chronic lung diseases and have several advantages over systemically-administered medications. These include more rapid onset of action for drugs such as β-adrenergic agonists when compared with oral medication, high luminal doses for inhaled antibiotics when used to treat endobronchial infection, and an improved therapeutic index compared with systemic delivery for these and other classes of drugs such as corticosteroids. The use of aerosolised drugs to treat patients whose tracheas are intubated is less well established, in part because systemic delivery via the intravenous route can be a simpler alternative for many drugs. Consequently, research in this area is largely limited to a number of in vitro studies and very few clinical trials. Unfortunately, a lack of focus in this area has resulted in a number of practices which at best are ineffective, and at worst dangerous for the patient. Although there have been some attempts to re-invigorate research in order to improve delivery systems, current devices are, to a great extent, based on long-standing technology developed more than 50 years ago. In this review, we explore current knowledge and provide guidance as to when and how the inhaled route may be of value when treating patients whose tracheas are intubated, and we set out the challenges facing those attempting to advance the topic. We conclude by reviewing current areas of interest that may lead to more effective and widespread use of aerosols in the treatment of intubated patients.

Inhaled Tranexamic Acid for Non-Massive Haemoptysis in a Rivaroxaban-Receiving Patient Not Responding to the Oral Form

“…Inhaled aerosolized medications are routinely used for various chronic lung diseases such as COPD, asthma and bronchiectasis, and were shown to offer several advantages over systemically administered medication. These include more rapid onset of action for drugs such as β-adrenergic agonists compared with oral medication, high luminal doses for inhaled antibiotics when used to treat endobronchial infection, and an improved therapeutic index compared with systemic delivery for other classes of drugs such as corticosteroids [3,9,10] . Our patient showed complete resolution of haemoptysis after administration of nebulized TXA 5 mg three times a day after failure to achieve significant improvement after 4 days of oral TXA.…”

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

“…Therefore, it is essential to evaluate the child's physical and cognitive abilities before using SMI in children. DPIs are not used in this patient population due to the requirement for a fast-forceful inspiration with DPIs (35)(36)(37)44,45).…”

“…Aerosols deposit in the central airways and poorly distributed in the lung due to non-uniform diseases such as localized bronchiectasis. Also, conditions such as purulent secretions in the airways, laryngospasm, enlarged tonsils and adenoids limit the delivery of aerosolized medications to the lung peripheries (45).…”

Terapia Inhalatoria en Pacientes Que Reciben Ventilación Mecánica

“…Por este motivo, muchos ventiladores incorporan el control y una línea de flujo propia para el nebulizador. Por otra parte, algunos ventiladores más modernos incluyen controles para operar un Nebulizador de Malla (NM) vibratoria, los que resultan muy atractivos por la ausencia de flujo extra al circuito, entre otras ventajas comparativas de estos dispositivos (11).…”