Aerosol therapy in young children

Inhalation of aerosolized drugs has become an established means for treatment of pulmonary diseases in the last fifiy years. The majoriry of aerosol therapy in childhood concerns inhaled corticosteroids and bronchodilators in the management of asthma. Administration of drugs via the inhaled route has major advantages over the oral route. The drug is targeted directly to its site of action, which results in a more rapid effect and a lower dose needed with less systemic side effects. However, to deliver the drug into the lungs reliably and reproducibly is difficult, especially in children. It requires understanding of the mechanisms of aerosol deposition in the lungs and knowledge about the factors affecting delivery and deposition of aerosols. There are several ways to deliver therapeutic aerosols to the lungs. The current methods can be classified in three categoties: nebulizers, pressurized metered dose inhales (pMDI's) with or without spacer, and dry powder inhalers (DPT's). Not all systems are suirable for use in young children. Application of aerosol therapy in young children requires a different approach compared vvith adults and older children. Factors such as age, co-operation, breathing pattern, nose breathing and size of the airways should be raken into account as they can have substantial effect on the dose delivered to the lungs. Nebulizers have long been the mainstay of aerosol therapy in children. Currently, the pMDI combined with spacer is recommended as the first choice for asthma therapy in young children. However, the pMDIIspacer and most other aerosol delivery systems were primarily designed for use in adults, and subsequently adapted for use in children. Furthermore, studying efficiency of aerosol delivery systems in young children is difficult and has ethical limitations. This explains why there is extended information available on the performance of aerosol delivery systems in adults, but only limited data in children. The use of drugs with potential side effects, such as corticosteroids, requires precise dosing with the administration of the lowest effective dose. Therefore, knowledge about the dose inhaled and factors affecting this dose for each particular drug, device and patient is necessary for optimal application of aerosol therapy. Better understanding of aerosol therapy in children is urgently needed.

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