Chest
Original Research: PEDIATRIC PROBLEMSAerosol Therapy by Pressured Metered-Dose Inhaler-Spacer in Sleeping Young Children: To Do or Not to Do?
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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Cited by (26)
Breathing easier: Addressing the challenges of aerosolizing medications to infants and preschoolers
2014, Respiratory MedicineCitation Excerpt :Research has suggested that because of the different breathing patterns in a sleeping child compared to an awake one, there is nearly doubling of the dose that is delivered to the trachea rather than the lower airways when aerosols are administered to the sleeping child [33]. Additionally, placement of a facemask often awakens the child and leads to difficulty with cooperation [34]. One might suspect that attempting to place a facemask over the mouth and nose of a sleeping child could terrify the child with a feeling of suffocation; thereby making future attempts at delivery more troublesome.
Asthma medication delivery: Mists and myths
2013, Paediatric Respiratory ReviewsCitation Excerpt :When breathing patterns recorded in awake and sleeping infants were used in an anatomically modeled infant airway model, deposition on filters attached to the spacer almost doubled in sleep but were still only about 5% of nominal dose.35 However, in a real life study, it became clear that administration during sleep is not an alternative as most infants woke up during administration and became distressed.36 This in turn led to the undesired high airflows, and lack of breath hold resulting in lower lung deposition.
Inhalation systems in childhood asthma
2012, Anales de Pediatria ContinuadaInhalation devices: Characteristics, modeling, regulation and use in routine practice. GAT Aerosolstorming, Paris 2011
2012, Revue des Maladies RespiratoiresSleep and Sleep Problems in Children with Medical Disorders
2012, Therapy in Sleep MedicineInhaled corticosteroid therapy with nebulized beclometasone dipropionate
2010, Pulmonary Pharmacology and TherapeuticsCitation Excerpt :However, it should be noted that this technique will only work if the sleep is not compromised. Indeed, in vitro studies with a breathing simulator showed the potential for improved drug delivery to the lungs during sleep, but in vivo studies reported a high percentage of children waking up, which resulted in a half the drug deposition as compared to administration during an awake state [56]. To address this issue, administration during sleep can be made with a hood, thus avoiding contact with the child's face.
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.