Delivery of inhaled medication in children
- Robert H Moore, MD
Robert H Moore, MD
- Associate Professor of Pediatrics
- Baylor College of Medicine
- Section Editors
- Gregory Redding, MD
Gregory Redding, MD
- Section Editor — Pediatric Pulmonology
- Professor of Pediatrics
- University of Washington School of Medicine
- Robert A Wood, MD
Robert A Wood, MD
- Editor-in-Chief — Allergy and Immunology
- Section Editor — Pediatric Allergy
- Professor of Pediatrics
- Johns Hopkins University School of Medicine
The delivery of aerosolized medication is an important component of treatment for many respiratory disorders and is a critical aspect of asthma management in children. Glucocorticoids, bronchodilators, antibiotics, and mucolytic agents can be administered via aerosol using a range of aerosol generating devices [1-4]. In addition, indications for aerosol therapy will broaden as novel macromolecular medications are delivered via the respiratory tract for the treatment of both pulmonary and systemic disorders [5,6]. (See "Delivery of inhaled medication in adults".)
The delivery of aerosolized medication to infants and children is complicated by anatomic and physiologic differences in their respiratory systems compared with adults [7-9]. Thus, a basic knowledge of the uses and limitations of aerosol delivery systems, the properties of effective aerosols, and the anatomic considerations affecting aerosol delivery in infants and children is essential to the optimal use of this therapeutic modality [10,11]. An overview of the delivery of inhaled medication in children will be presented here; specific aspects of medication delivery using nebulizers, pressurized metered dose inhalers (MDIs), and dry powder inhalers (DPIs) are discussed separately. (See "Use of medication nebulizers in children" and "The use of inhaler devices in children".)
ADVANTAGES OF AEROSOLIZED DRUG DELIVERY
There are several advantages to delivering drugs by aerosol rather than systemically:
●Delivery of agents directly to their sites of action decreases the dose required for therapeutic effect.
●Faster onset of action (compared with intravenous delivery) of bronchodilating medications allows more rapid reversal of acute bronchoconstriction.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Fink JB. Aerosol device selection: evidence to practice. Respir Care 2000; 45:874.
- Dolovich MA, MacIntyre NR, Anderson PJ, et al. Consensus statement: aerosols and delivery devices. American Association for Respiratory Care. Respir Care 2000; 45:589.
- Hess D. Aerosol therapy. Respir Care Clin N Am 1995; 1:235.
- Roche N, Huchon GJ. Rationale for the choice of an aerosol delivery system. J Aerosol Med 2000; 13:393.
- Rubin BK. Experimental macromolecular aerosol therapy. Respir Care 2000; 45:684.
- Newhouse MT, Corkery KJ. Aerosols for systemic delivery of macromolecules. Respir Care Clin N Am 2001; 7:261.
- Rubin BK, Fink JB. Aerosol therapy for children. Respir Care Clin N Am 2001; 7:175.
- Everard ML. Aerosol delivery in infants and young children. J Aerosol Med 1996; 9:71.
- Cole CH. Special problems in aerosol delivery: neonatal and pediatric considerations. Respir Care 2000; 45:646.
- O'Callaghan C, Barry PW. Asthma drug delivery devices for children. BMJ 2000; 320:664.
- 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.
- Diot P, Dequin PF, Rivoire B, et al. Aerosols and anti-infectious agents. J Aerosol Med 2001; 14:55.
- Gilbert BE. Liposomal aerosols in the management of pulmonary infections. J Aerosol Med 1996; 9:111.
- Roth C, Gebhart J, Just-Nübling G, et al. Characterization of amphotericin B aerosols for inhalation treatment of pulmonary aspergillosis. Infection 1996; 24:354.
- 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.
- Sherman JM. Breaking the cycle: lidocaine therapy for habit cough. J Fla Med Assoc 1997; 84:308.
- Cohen SP, Dawson TC. Nebulized morphine as a treatment for dyspnea in a child with cystic fibrosis. Pediatrics 2002; 110:e38.
- Le Souëf P. The meaning of lung dose. Allergy 1999; 54 Suppl 49:93.
- Brain JD, Valberg PA. Deposition of aerosol in the respiratory tract. Am Rev Respir Dis 1979; 120:1325.
- Dolovich M, Smaldone GC. Estimating the particle size characteristics of therapeutic aerosols. J Aerosol Med 1999; 12:215.
- Newhouse MT, Ruffin RE. Deposition and fate of aerosolized drugs. Chest 1978; 73:936.
- 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.
- Zeidler M, Corren J. Hydrofluoroalkane formulations of inhaled corticosteroids for the treatment of asthma. Treat Respir Med 2004; 3:35.
- O'Callaghan C. Delivery systems: the science. Pediatr Pulmonol Suppl 1997; 15:51.
- Barry PW, O'Callaghan C. Nebuliser therapy in childhood. Thorax 1997; 52 Suppl 2:S78.
- Collis GG, Cole CH, Le Souëf PN. Dilution of nebulised aerosols by air entrainment in children. Lancet 1990; 336:341.
- Onhøj J, Thorsson L, Bisgaard H. Lung deposition of inhaled drugs increases with age. Am J Respir Crit Care Med 2000; 162:1819.
- Iles R, Lister P, Edmunds AT. Crying significantly reduces absorption of aerosolised drug in infants. Arch Dis Child 1999; 81:163.
- 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.
- 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.
- 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.
- 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.
- Nikander K. Drug delivery systems. J Aerosol Med 1994; 7:S19.
- Amirav I, Newhouse MT. Review of optimal characteristics of face-masks for valved-holding chambers (VHCs). Pediatr Pulmonol 2008; 43:268.
- Lowenthal D, Kattan M. Facemasks versus mouthpieces for aerosol treatment of asthmatic children. Pediatr Pulmonol 1992; 14:192.
- 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.
- 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.
- Erzinger S, Schueepp KG, Brooks-Wildhaber J, et al. Facemasks and aerosol delivery in vivo. J Aerosol Med 2007; 20 Suppl 1:S78.
- O'Callaghan C, Barry PW. The science of nebulised drug delivery. Thorax 1997; 52 Suppl 2:S31.
- ADVANTAGES OF AEROSOLIZED DRUG DELIVERY
- TYPES OF AEROSOL DELIVERY DEVICES
- LUNG DISEASES MANAGED USING AEROSOL THERAPY
- PROPERTIES OF AN IDEAL AEROSOL THERAPY DEVICE
- FACTORS AFFECTING DRUG DEPOSITION
- Properties of the device
- Aerosol properties
- Properties of medication to be delivered
- Disease state and ventilatory pattern
- Patient technique, acceptance, and preference
- SPECIAL CONSIDERATIONS IN INFANTS AND YOUNG CHILDREN
- Respiratory pattern
- INFORMATION FOR PATIENTS