Delivery of inhaled medication in children: Revisiting Pharmacological and Practical Issues for Better Health Outcome
Abstract
For safe and effective therapy of respiratory disorders in children, delivering the medication at the site of disease i.e. directly into the respiratory tract via aerosolized medication is critical. But, the anatomical and physiological differences in the respiratory tract of infants/children and adults make the delivery of aerosolized medication complicated. This review article will give an overview of the delivery of inhaled medication in children and discuss the pharmacological and specific clinically relevant aspects of medication delivery using nebulizers, pressurized metered dose inhalers (MDIs), and dry powder inhalers (DPIs) in children.
1. Fink JB. Aerosol device selection: evidence to pratice. Respir Care 2000; 45:874.
2. Dolovich MA, MacIntyre NR, Anderson PJ, et al. Consensus statement: aerosols and delivery devices. American Association for Respiratory Care. Respir Care 2000; 45:589.
3. Hess D. Aerosol therapy. Respir Care Clin N Am 1995; 1:235.
4. Roche N, Huchon GJ. Rationale for the choice of an aerosol delivery system. J Aerosol Med 2000; 13:393.
5. Rubin BK. Experimental macromolecular aerosol therapy. Respir Care 2000; 45:684.
6. Newhouse MT, Corkery KJ. Aerosols for systemic delivery of macromolecules. Respir Care Clin N Am 2001; 7:261.
7. Rubin BK, Fink JB. Aerosol therapy for children. Respir Care Clin N Am 2001; 7:175.
8. Everard ML. Aerosol delivery in infants and young children. J Aerosol Med 1996; 9:71.
9. Cole CH. Special problems in aerosol delivery: neonatal and pediatric considerations. Respir Care 2000; 45:646.
10. O'Callaghan C, Barry PW. Asthma drug delivery devices for children. BMJ 2000; 320:664.
11. Brocklebank D, Ram F, Wright J, et al. Comparison of the effectiveness of inhaler devices in asthma and chronic obstructive airways disease: a systematic review of the literature. Health Technol Assess 2001; 5:1.
12. Diot P, Dequin PF, Rivoire B, et al. Aerosols and anti-infectious agents. J Aerosol Med 2001; 14:55.
13. Gilbert BE. Liposomal aerosols in the management of pulmonary infections. J Aerosol Med 1996; 9:111.
14. Roth C, Gebhart J, Just-Nübling G, et al. Characterization of amphotericin B aerosols for inhalation treatment of pulmonary aspergillosis. Infection 1996; 24:354.
15. Simonds AK, Newman SP, Johnson MA, et al. Alveolar targeting of aerosol pentamidine. Toward a rational delivery system. Am Rev Respir Dis 1990; 141:827.
16. Sherman JM. Breaking the cycle: lidocaine therapy for habit cough. J Fla Med Assoc 1997; 84:308.
17. Cohen SP, Dawson TC. Nebulized morphine as a treatment for dyspnea in a child with cystic fibrosis. Pediatrics 2002; 110:e38.
18. Le Souëf P. The meaning of lung dose. Allergy 1999; 54 Suppl 49:93.
19. Brain JD, Valberg PA. Deposition of aerosol in the respiratory tract. Am Rev Respir Dis 1979; 120:1325.
20. Dolovich M, Smaldone GC. Estimating the particle size characteristics of therapeutic aerosols. J Aerosol Med 1999; 12:215.
21. Newhouse MT, Ruffin RE. Deposition and fate of aerosolized drugs. Chest 1978; 73:936.
22. Amirav I, Balanov I, Gorenberg M, et al. Beta-agonist aerosol distribution in respiratory syncytial virus bronchiolitis in infants. J Nucl Med 2002; 43:487.
23. Zeidler M, Corren J. Hydrofluoroalkane formulations of inhaled corticosteroids for the treatment of asthma. Treat Respir Med 2004; 3:35.
24. O'Callaghan C. Delivery systems: the science. Pediatr Pulmonol Suppl 1997; 15:51.
25. Barry PW, O'Callaghan C. Nebuliser therapy in childhood. Thorax 1997; 52 Suppl 2:S78.
26. Collis GG, Cole CH, Le Souëf PN. Dilution of nebulised aerosols by air entrainment in children. Lancet 1990; 336:341.
27. Onhøj J, Thorsson L, Bisgaard H. Lung deposition of inhaled drugs increases with age. Am J Respir Crit Care Med 2000; 162:1819.
28. Iles R, Lister P, Edmunds AT. Crying significantly reduces absorption of aerosolised drug in infants. Arch Dis Child 1999; 81:163.
29. Wildhaber JH, Dore ND, Wilson JM, et al. Inhalation therapy in asthma: nebulizer or pressurized metered-dose inhaler with holding chamber? In vivo comparison of lung deposition in children. J Pediatr 1999; 135:28.
30. Janssens HM, van der Wiel EC, Verbraak AF, et al. Aerosol therapy and the fighting toddler: is administration during sleep an alternative? J Aerosol Med 2003; 16:395.
31. Clarke JR, Aston H, Silverman M. Delivery of salbutamol by metered dose inhaler and valved spacer to wheezy infants: effect on bronchial responsiveness. Arch Dis Child 1993; 69:125.
32. Esposito-Festen J, Ijsselstijn H, Hop W, et al. Aerosol therapy by pressured metered-dose inhaler-spacer in sleeping young children: to do or not to do? Chest 2006; 130:487.
33. Nikander K. Drug delivery systems. J Aerosol Med 1994; 7:S19.
34. Amirav I, Newhouse MT. Review of optimal characteristics of face-masks for valved-holding chambers (VHCs). Pediatr Pulmonol 2008; 43:268.
35. Lowenthal D, Kattan M. Facemasks versus mouthpieces for aerosol treatment of asthmatic children. Pediatr Pulmonol 1992; 14:192.
36. Mellon M, Leflein J, Walton-Bowen K, et al. Comparable efficacy of administration with face mask or mouthpiece of nebulized budesonide inhalation suspension for infants and young children with persistent asthma. Am J Respir Crit Care Med 2000; 162:593.
37. El Mallah MK, Hendeles L. Delivery of medications by metered dose inhaler through a chamber/mask to young children with asthma. Pediatr Allergy Immunol Pulmonol 2012; 25:236.
38. Erzinger S, Schueepp KG, Brooks-Wildhaber J, et al. Facemasks and aerosol delivery in vivo. J Aerosol Med 2007; 20 Suppl 1:S78.
39. O'Callaghan C, Barry PW. The science of nebulised drug delivery. Thorax 1997; 52 Suppl 2:S31.
40. More K, Sakhuja P, Shah PS. Minimally invasive surfactant administration in preterm infants. A meta-narrative review. JAMA Pediatr. 2014; 168: 901–8.
41. Strong P, Ito K, Murray J, Rapeport G. Current approaches to the discovery of novel inhaled medicines. Drug Discov Today 2018;23:1705 17.
42. Roberts CT, Halibullah I, Bhatia R et al. Outcomes after introduction of minimally invasive surfactant therapy in two Australian tertiary units. J. Pediatr. 2020; 229: 141–6.
43. Dargaville PA, Ali SKM, Jackson HM, Williams C, De Paoli AG. Impact of minimally invasive surfactant therapy in preterm infants at 29-32 weeks gestation. Neonatology 2018; 113: 7–14.
44. Owen LS, Manley BJ, Davis PG, Doyle LW. The evolution of modern respiratory care for preterm infants. Lancet 2017; 389: 1649–59.
45. Al Moamary MS, Alhaider SA, Alangari AA, Al Ghobain MO, Zeitouni MO, Idrees MM, et al. The Saudi Initiative for Asthma – 2019 Update: Guidelines for the diagnosis and management of asthma in adults and children. Ann Thorac Med 2019;14:3-48.
2. Dolovich MA, MacIntyre NR, Anderson PJ, et al. Consensus statement: aerosols and delivery devices. American Association for Respiratory Care. Respir Care 2000; 45:589.
3. Hess D. Aerosol therapy. Respir Care Clin N Am 1995; 1:235.
4. Roche N, Huchon GJ. Rationale for the choice of an aerosol delivery system. J Aerosol Med 2000; 13:393.
5. Rubin BK. Experimental macromolecular aerosol therapy. Respir Care 2000; 45:684.
6. Newhouse MT, Corkery KJ. Aerosols for systemic delivery of macromolecules. Respir Care Clin N Am 2001; 7:261.
7. Rubin BK, Fink JB. Aerosol therapy for children. Respir Care Clin N Am 2001; 7:175.
8. Everard ML. Aerosol delivery in infants and young children. J Aerosol Med 1996; 9:71.
9. Cole CH. Special problems in aerosol delivery: neonatal and pediatric considerations. Respir Care 2000; 45:646.
10. O'Callaghan C, Barry PW. Asthma drug delivery devices for children. BMJ 2000; 320:664.
11. Brocklebank D, Ram F, Wright J, et al. Comparison of the effectiveness of inhaler devices in asthma and chronic obstructive airways disease: a systematic review of the literature. Health Technol Assess 2001; 5:1.
12. Diot P, Dequin PF, Rivoire B, et al. Aerosols and anti-infectious agents. J Aerosol Med 2001; 14:55.
13. Gilbert BE. Liposomal aerosols in the management of pulmonary infections. J Aerosol Med 1996; 9:111.
14. Roth C, Gebhart J, Just-Nübling G, et al. Characterization of amphotericin B aerosols for inhalation treatment of pulmonary aspergillosis. Infection 1996; 24:354.
15. Simonds AK, Newman SP, Johnson MA, et al. Alveolar targeting of aerosol pentamidine. Toward a rational delivery system. Am Rev Respir Dis 1990; 141:827.
16. Sherman JM. Breaking the cycle: lidocaine therapy for habit cough. J Fla Med Assoc 1997; 84:308.
17. Cohen SP, Dawson TC. Nebulized morphine as a treatment for dyspnea in a child with cystic fibrosis. Pediatrics 2002; 110:e38.
18. Le Souëf P. The meaning of lung dose. Allergy 1999; 54 Suppl 49:93.
19. Brain JD, Valberg PA. Deposition of aerosol in the respiratory tract. Am Rev Respir Dis 1979; 120:1325.
20. Dolovich M, Smaldone GC. Estimating the particle size characteristics of therapeutic aerosols. J Aerosol Med 1999; 12:215.
21. Newhouse MT, Ruffin RE. Deposition and fate of aerosolized drugs. Chest 1978; 73:936.
22. Amirav I, Balanov I, Gorenberg M, et al. Beta-agonist aerosol distribution in respiratory syncytial virus bronchiolitis in infants. J Nucl Med 2002; 43:487.
23. Zeidler M, Corren J. Hydrofluoroalkane formulations of inhaled corticosteroids for the treatment of asthma. Treat Respir Med 2004; 3:35.
24. O'Callaghan C. Delivery systems: the science. Pediatr Pulmonol Suppl 1997; 15:51.
25. Barry PW, O'Callaghan C. Nebuliser therapy in childhood. Thorax 1997; 52 Suppl 2:S78.
26. Collis GG, Cole CH, Le Souëf PN. Dilution of nebulised aerosols by air entrainment in children. Lancet 1990; 336:341.
27. Onhøj J, Thorsson L, Bisgaard H. Lung deposition of inhaled drugs increases with age. Am J Respir Crit Care Med 2000; 162:1819.
28. Iles R, Lister P, Edmunds AT. Crying significantly reduces absorption of aerosolised drug in infants. Arch Dis Child 1999; 81:163.
29. Wildhaber JH, Dore ND, Wilson JM, et al. Inhalation therapy in asthma: nebulizer or pressurized metered-dose inhaler with holding chamber? In vivo comparison of lung deposition in children. J Pediatr 1999; 135:28.
30. Janssens HM, van der Wiel EC, Verbraak AF, et al. Aerosol therapy and the fighting toddler: is administration during sleep an alternative? J Aerosol Med 2003; 16:395.
31. Clarke JR, Aston H, Silverman M. Delivery of salbutamol by metered dose inhaler and valved spacer to wheezy infants: effect on bronchial responsiveness. Arch Dis Child 1993; 69:125.
32. Esposito-Festen J, Ijsselstijn H, Hop W, et al. Aerosol therapy by pressured metered-dose inhaler-spacer in sleeping young children: to do or not to do? Chest 2006; 130:487.
33. Nikander K. Drug delivery systems. J Aerosol Med 1994; 7:S19.
34. Amirav I, Newhouse MT. Review of optimal characteristics of face-masks for valved-holding chambers (VHCs). Pediatr Pulmonol 2008; 43:268.
35. Lowenthal D, Kattan M. Facemasks versus mouthpieces for aerosol treatment of asthmatic children. Pediatr Pulmonol 1992; 14:192.
36. Mellon M, Leflein J, Walton-Bowen K, et al. Comparable efficacy of administration with face mask or mouthpiece of nebulized budesonide inhalation suspension for infants and young children with persistent asthma. Am J Respir Crit Care Med 2000; 162:593.
37. El Mallah MK, Hendeles L. Delivery of medications by metered dose inhaler through a chamber/mask to young children with asthma. Pediatr Allergy Immunol Pulmonol 2012; 25:236.
38. Erzinger S, Schueepp KG, Brooks-Wildhaber J, et al. Facemasks and aerosol delivery in vivo. J Aerosol Med 2007; 20 Suppl 1:S78.
39. O'Callaghan C, Barry PW. The science of nebulised drug delivery. Thorax 1997; 52 Suppl 2:S31.
40. More K, Sakhuja P, Shah PS. Minimally invasive surfactant administration in preterm infants. A meta-narrative review. JAMA Pediatr. 2014; 168: 901–8.
41. Strong P, Ito K, Murray J, Rapeport G. Current approaches to the discovery of novel inhaled medicines. Drug Discov Today 2018;23:1705 17.
42. Roberts CT, Halibullah I, Bhatia R et al. Outcomes after introduction of minimally invasive surfactant therapy in two Australian tertiary units. J. Pediatr. 2020; 229: 141–6.
43. Dargaville PA, Ali SKM, Jackson HM, Williams C, De Paoli AG. Impact of minimally invasive surfactant therapy in preterm infants at 29-32 weeks gestation. Neonatology 2018; 113: 7–14.
44. Owen LS, Manley BJ, Davis PG, Doyle LW. The evolution of modern respiratory care for preterm infants. Lancet 2017; 389: 1649–59.
45. Al Moamary MS, Alhaider SA, Alangari AA, Al Ghobain MO, Zeitouni MO, Idrees MM, et al. The Saudi Initiative for Asthma – 2019 Update: Guidelines for the diagnosis and management of asthma in adults and children. Ann Thorac Med 2019;14:3-48.
| Files | ||
| Issue | Vol 12, No 1 (Winter 2024) | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/jpc.v12i1.16030 | |
| Keywords | ||
| Aerosol MDIs DPIs Respiratory diseases Children | ||
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How to Cite
1.
Mishra P. Delivery of inhaled medication in children: Revisiting Pharmacological and Practical Issues for Better Health Outcome. J Pharm Care. 2024;12(1):47-54.
