Inhalation therapy in asthma: Nebulizer or pressurized metered-dose inhaler with holding chamber? In vivo comparison of lung deposition in children,☆☆

https://doi.org/10.1016/S0022-3476(99)70323-9Get rights and content

Abstract

Objective: To compare lung deposition from a nebulizer and a pressurized metered-dose inhaler (pMDI)/holding chamber to determine their efficiency in aerosol delivery to children. Study design: Children with stable asthma (n = 17) aged 2 to 9 years inhaled in random order radiolabeled salbutamol from a nebulizer and a pMDI through a nonstatic holding chamber. Body and lung deposition of radiolabeled salbutamol was assessed with a gamma camera. Results: Mean (absolute dose) total lung deposition expressed as a percentage of the nebulized dose was 5.4% (108 μg) in younger children (<4 years) and 11.1% (222 μg) in older children (>4 years). Mean (absolute dose) total lung deposition expressed as a percentage of the metered dose was 5.4% (21.6 μg) in younger and 9.6% (38.4 μg) in older children. Conclusions: For the same age groups we have shown equivalent percentages of total lung deposition of radiolabeled salbutamol aerosolized by either a nebulizer or a pMDI/holding chamber. However, the delivery rate per minute and the total dose of salbutamol deposited were significantly higher for the nebulizer. (J Pediatr 1999;135:28-33)

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.

References (31)

  • KJ Chou et al.

    Metered dose inhalers with spacers versus nebulizers for pediatric asthma

    Arch Pediatr Adolesc Med

    (1995)
  • YZ Lin et al.

    Metered dose inhaler and nebulizer in acute asthma

    Arch Dis Child

    (1995)
  • G Fuglesång et al.

    Comparison of nebuhaler and nebulizer treatment of acute severe asthma in children

    Eur J Respir Dis

    (1986)
  • HL Chua et al.

    The influence of age on aerosol deposition in children with cystic fibrosis

    Eur Respir J

    (1994)
  • TF Fok et al.

    Efficiency of aerosol medication delivery from a metered dose inhaler versus jet nebulizer in infants with bronchopulmonary dysplasia

    Pediatr Pulmonol

    (1996)
  • Cited by (141)

    • 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 Technology
      Citation 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 Edition
    • Protein stability in pulmonary drug delivery via nebulization

      2015, Advanced Drug Delivery Reviews
      Citation 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.

    • Delivery of inhalation drugs to children for asthma and other respiratory diseases

      2014, Advanced Drug Delivery Reviews
      Citation 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
    View all citing articles on Scopus

    Reprint requests: Johannes Wildhaber, MD, University Children’s Hospital, Steinweisstrasse 75, CH-8032 Zurich, Switzerland.

    ☆☆

    0022-3476/99/$8.00 + 0  9/21/96308

    View full text