Inhalation therapy in asthma: Nebulizer or pressurized metered-dose inhaler with holding chamber? In vivo comparison of lung deposition in children☆,☆☆
Section snippets
Subjects
Seventeen children (13 boys) aged 2 to 9 years with asthma diagnosed according to the International Consensus Report on Diagnosis and Management of Asthma were recruited. Each patient had asthma in a stable state as judged by the absence of an exacerbation in the preceding 4 weeks and, where possible to measure, a forced expiratory volume (first second) >80% of predicted. Patients underwent a prestudy evaluation that included clinical examination and instruction in the optimal use of the
RESULTS
The mass median aerosol diameter from the nebulizer (n = 20) was 3.21 μm (SD 0.07). The drug particle size distributions from commercial and labeled salbutamol pMDIs compared with the distribution of the radioactivity assessed with the multistage liquid impinger showed a good correspondence. The mean (SD) amount of small particles (<3.1 μm) from stage 4, expressed as a percentage of the metered dose, was 39.8% (1.3), 41.4% (1.9), and 42.0% (3.5) for the drug from unlabeled commercial Ventolin
DISCUSSION
This study demonstrates that a nebulizer and a pMDI/holding chamber can be equally efficient in delivery of β2-agonists to the lungs of asthmatic children. However, a much higher absolute dose can be delivered from the nebulizer compared with the pMDI/ holding chamber, because the starting dose is much higher. A nebulizer also delivers a higher dose, when its longer inhalation time is taken into account and the total deposited dose is expressed as the dose deposited per minute of inhalation.
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Update efficacy of aerosol therapy with noninvasive ventilator approach (non-invasive ventilation and nasal high flow): Aerosol delivery via noninvasive ventilation
2020, Journal of Drug Delivery Science and TechnologyCitation Excerpt :pMDIs exhibit many advantages including; portability, lower cost, dose consistency, and saving time if compared to nebulizers [16–20]. Their major drawback includes the difficulty of administering drug cocktails [21–23]. Dose emission by pMDIs is recommended to be at the beginning of the inspiration phase within the NIV circuit.
Special Considerations for Infants and Young Children
2016, Pediatric Allergy: Principles and Practice: Third EditionProtein stability in pulmonary drug delivery via nebulization
2015, Advanced Drug Delivery ReviewsCitation Excerpt :A significant amount of medication is wasted since these devices have a residual “dead” volume of 0.5 to 1.5 mL and usually operate continuously also during exhalation phases. Thus while the respirable fraction of the generated aerosol is in a range of 30–70% [122], only 5–15% of the initial charge actually deposits in the lung [123–127]. This is a significant disadvantage considering the comparably high value of biopharmaceuticals.
The systemic exposure to inhaled beclometasone/formoterol pMDI with valved holding chamber is independent of age and body size
2015, Pulmonary Pharmacology and TherapeuticsDelivery of inhalation drugs to children for asthma and other respiratory diseases
2014, Advanced Drug Delivery ReviewsCitation Excerpt :This consequently reduces the amount of particles that travel further downstream [8]. The higher total and oropharyngeal deposition [18–20], as well as lower lung deposition [19–24], in younger children have been observed in in vivo studies. The higher total and oropharyngeal deposition for particles ≥ 5 μm was predicted by the paediatric model by Xu and Yu discussed above [10], whereas the lower lung deposition with age is in line with the model by Phalen et al. [11].
Evidence based design of face masks for infants
2013, International Journal of Pharmaceutics
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Reprint requests: Johannes Wildhaber, MD, University Children’s Hospital, Steinweisstrasse 75, CH-8032 Zurich, Switzerland.
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