Aerosol therapy in the newborn

Article Abstract:

Aerosol therapy has been used for the management of respiratory tract conditions in both adults and children. Recently, this therapy has been considered for use in treating respiratory disorders in newborn infants. Two categories of agents, beta agonist bronchodilators and anticholinergic agents, are effective in mechanically ventilated and also freely breathing infants. There are many other drugs with potential uses for infants with a variety of respiratory conditions. There is also a variety of equipment used to deliver medications to the respiratory tract, including metered-dose inhalers, jet nebulizers, ultrasonic nebulizers, and dry-powder generators. Spacers may be used to deliver drugs with small particle size. The output of these therapeutic aerosols has not been standardized and the appropriate size and distribution of aerosol for a newborn infant is not known. Additional research is needed to understand the effects of inhaled drugs on the newborn lung for both short-term and long-term use. A panel of experts that convened at a workshop in December 1989 concluded that it was important to measure the droplet size delivered to the respiratory tract and the dose that reaches the lung. The group also believes it is necessary to study further the distribution of drugs within the lungs using animal models before conducting studies in infants. The ideal delivery system for use in infants has not been determined and the dose delivered needs to be estimated before using aerosols in treating newborns. Finally, the group concluded that the technical problems of delivering suspended particles by aerosol urgently need to be solved. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Demographic aspects, Infants, Respiratory therapy, Aerosol therapy

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How much aerosol reaches the lungs of wheezy infants and toddlers?

Article Abstract:

Therapy using inhaled drugs for the treatment of asthma often appears to be ineffective in infants and toddlers with symptoms of wheezing. Studies of drug delivery in children have not been performed because radioactive materials or other techniques that are potentially harmful to children are used to estimate the amount of drug that gets to the lungs. A study was designed to estimate safely the amount of drug that reaches the lungs of children by using sodium cromoglycate, a non-toxic substance that appears in the urine if it is absorbed by the lungs. Sodium cromoglycate was administered through a face mask using a metered dose inhaler on one study day and by an atomizer (nebulizer) on another study day to nine boys, ages 9 to 36 months, with frequent wheezy episodes. Also, seven healthy adults were dosed nasally using a nebulizer to compare the efficiency of drug delivery in adults and children. Urine samples were collected from all subjects before and after drug administration; the amount of sodium cromoglycate appearing in the urine reflected the absorption from the lungs. Children treated with a nebulizer excreted almost three times more sodium cromoglycate than children treated with a metered dose inhaler. In addition, nebulized adults excreted twice as much as nebulized children. It appears that the nose filters out three-quarters of the dose received by mouth breathing, and improved methods of drug delivery are needed to circumvent the inhibitory effect of nose breathing. Ineffectiveness of drug treatment in young children may be partially due to inadequate drug delivery to the lungs. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Aerosols, Cromolyn sodium

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Treatment of acute, episodic asthma in preschool children using intermittent high dose inhaled steroids at home

Article Abstract:

The standard treatment for attacks of acute asthma in preschool-age children is oral steroids with inhaled bronchodilator therapy. But the number of hospitalizations for acute asthma in this age group is increasing, therefore this method of therapy appears to be relatively ineffective. An experiment was designed to test the effectiveness of inhaled steroids for asthma attacks in young children; this approach is meant to avoid the complications associated with long-term oral steroid treatment. Inhalers containing placebo (an inactive substance) and the steroid, beclomethasone dipropionate, were tested in a double-blind study with 24 children, ages one to five years, who had episodes of wheezing during the previous months. Treatment started at home and lasted for five days after parents noticed evidence of an asthma attack; the parents recorded respiratory and systemic (affecting the whole body) symptoms, as well as their opinion as to the effectiveness of the specific inhaler. Although more parents thought that the steroid inhaler was more useful than the placebo inhaler, only a marginal reduction of symptoms occurred during acute asthma attacks. Potential explanations for these results include that the length of treatment time and drug dose were selected arbitrarily, and children who were not recruited from a hospital outpatient setting and thus were less severely distressed might have benefitted more from the experimental design. Despite some methodological problems, inhaled steroids may provide a therapeutic alternative for treatment of acute asthma in young children. (Consumer Summary produced by Reliance Medical Information, Inc.)

Corticosteroids, Adrenocortical hormones

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