Chest
Volume 130, Issue 2, August 2006, Pages 487-492
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Original Research: PEDIATRIC PROBLEMS
Aerosol Therapy by Pressured Metered-Dose Inhaler-Spacer in Sleeping Young Children: To Do or Not to Do?

https://doi.org/10.1378/chest.130.2.487Get rights and content

One third of young children are distressed during inhalation therapy. It has been suggested that administration during sleep could be a good alternative for these children. A laboratory study in our department using an infant upper airway model showed significantly higher lung doses from a pressured metered-dose inhaler (pMDI)-spacer for sleep-breathing patterns compared with wake-breathing patterns.

Objective

We set up a daily life study to investigate the feasibility of aerosol administration by means of pMDI-spacer in sleeping young children.

Design

Over a period of 3 weeks, 30 children (age range, 6 to 23 months) with recurrent wheeze daily inhaled 1 puff of budesonide aerosol (200 μg) while awake and 1 puff during sleep. Filters positioned between the chamber and the facemask trapped the budesonide aerosol. Parents scored the child's asthma symptoms, degree of cooperation, and feasibility of administration on diary cards.

Results

In 69% of the sleep administrations, the children woke up, and in 75% of these cases the children were distressed. The mean filter dose (expressed as the percentage of the nominal dose) while awake was 47%, and during sleep it was 16% (p = 0.007). The median within-subject dose variability while awake was 50%, and during sleep it was 110% (p = 0.007).

Conclusion

Aerosol administration by means of pMDI-spacer during sleep offers no advantage and is not a feasible treatment option in most young children.

Section snippets

Study Population

Thirty children between the ages of 6 and 23 months were recruited from the outpatient clinics of Erasmus MC-Sophia Children's Hospital (Rotterdam, the Netherlands), St. Franciscus Gasthuis (Rotterdam, the Netherlands), Reinier de Graaf Gasthuis (Delft, the Netherlands), and Albert Schweitzer Ziekenhuis (Dordrecht, the Netherlands). They all had been treated with twice-daily inhalation therapy for recurrent wheeze for at least the previous month. Children with cardiac disease or another

RESULTS

Thirty children (18 boys) entered the study. The results from three children were excluded from analysis because the parents had not complied with the protocol. Six children did not complete the third study week, because they were too distressed during the “sleep administration.” The missing data for these children were accounted for in the analysis. Twenty-one children fully completed the study. A total number of 350 and 331 filters, respectively, were collected for awake administration and

DISCUSSION

The aim of our study was to investigate the feasibility of aerosol administration in sleeping young children in a daily-life situation. Sleep administration was found to be possible in no more than one third of the children. Moreover, filter doses of sleeping children were substantially lower than the filter doses obtained during the awake administration.

Several studies23816 have shown that inhalation therapy by means of pMDI-spacer can be effective in the treatment of recurrent wheezing in

ACKNOWLEDGMENT

The authors thank all of the children and parents for their participation in this study. Dr. R. Schornagel and Dr. P.J.C van der Straaten are gratefully acknowledged for the recruitment of patients in their hospitals.

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    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestjournal.org/misc/reprints.shtml)

    This study was supported by an unrestricted grant from Astra-Zeneca, the Netherlands.

    Drs. Hop and de Jongste have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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