Focus
La terapia inalatoria
AEROSOL THERAPY
A. Battistini
Dicembre 2007 - pagg. 631 -644
Abstract
The percentage of a prescribed drug that is able to reach the lung (delivery power) is low
and varies widely when both nebulizers, pneumatic and ultrasonic, are used. The Metered-
Doser Inhaler (MDI) has a higher and more constant efficiency, moreover when associated
to a spacer provided with valves, it zeroes the ballistic effect (the impact of the drug with
the oropharynx) and makes the procedure suitable for all ages. Conversely, Dry Powder
Inhaler enhances the ballistic effect and requires a much higher patient collaboration. Independently
from the technique used, the percentage of drug that actually reaches the lung in
the child is much lower than that in adult (2-6% versus 16-20%): hence the necessity to reconsider
the dosages via inhalation for paediatric use. In order to get the best collaboration
on behalf of the parents it is mandatory that they are instructed on the basics of inhalation
therapy and shown the correct procedure.
Classificazione MeSH
Bibliografia
1. Powell CV, Maskell GR, Marks MK, et al.
Successful implementation of spacer treatment:
guideline for acute asthma. Arch Dis
Child 2001;84:142-6.
2. Crompton GK. Inhaler technique blind spot. Eur Respir J 2006;27:1070-1.
3. Battistini A. Come attuare al meglio la terapia aerosolica. Parte 1: Le metodiche. Ped Med Chir 1995;17:97-103.
4. Battistini A. Come attuare al meglio la terapia aerosolica. Parte 2: I farmaci. Ped Med Chir 1995;17:189-96.
5. Leung K, Louca E, Coates AL. Comparison of breath-enhanced to breath-actuated nebulizers for rate, consistency, and efficiency. Chest 2004;126:1619-27.
6. Amirav I, Balanov I, et al. Nebuliser hood compared to mask in wheezy infants. Arch Dis Child 2003;88:719-23.
7. Rodrigo GJ. Delivery of b-agonists in the emergency department setting. Chest 2005; 127:1890.
8. Rivera ML, Kim TV, Stewart GM. Albuterol nebulized in heliox in the initial ED treatment of pediatric asthma: a blinded, randomized controlled trial. Am J Emerg Med 2006;24:38-42.
9. Battistini A. Terapia inalatoria: come. Pneumorama 1997;3;14-21.
10. Roller CM, Zhang G, Troedson RG, et al. Spacer inhalation technique and deposition of extrafine aerosol in asthmatic children. Eur Respir J 2006 (Epub ahead of print).
11. Hess DR. Metered-Dose Inhalers and Dry Powder Inhalers in aerosol therapy. Respiratory Care 2005;50:1376-82.
12. Rubin BK. What does it mean when a patient says, “my asthma medication is not working?” Chest 2004;126:972-81.
13. Roller CM, Zhang G, Troedson RG. Spacer inhalation technique and deposition of extrafine aerosol in asthmatic children. Eur Respir J 2007;29:299-306.
14. Lipworth BJ, Sims EJ, Taylor K, et al. Dose- response to salbutamol via a novel palm sized nebuliser (Aerodose Inhaler), conventional nebuliser (Pari LC Plus) and metered dose inhaler (Ventolin Evohaler) in moderate to severe asthmatics. Br J Clin Pharmacol 2005;59:5-13.
15. Hayden JT, Smith N, Woolf DA, et al. A randomised crossover trial of face mask efficacy. Arch Dis Child 2004;89:72-3.
16. Rastogi D, Shetty A, Neugebauer R, et al. National Heart, Lung and Blood Institute Guidelines and asthma management practice among inner-city pediatric primary care providers. Chest 2006;129:619-23.
17. Chaney G, Clements B, Landau L. A new asthma spacer device to improve compliance in children: a pilot study. Respirology 2004,9:499-506.
18. Amirav I. Treatment failure in children with asthma due to inappropriate use of Turbohaler. J Pediatr 2002;140:483.
19. Cochrane MG, Mohan VB, Downs KE, et al. Inhaled corticosteroids for asthma therapy. Patients compliance, device and inhalation technique. Chest 2000;117:542-50.
20. Taylor DR, Iijnenburg MW, Smith AD. Exhaled nitric oxide measurement: clinical application and interpretation. Thorax 2006; 61:817-27.
21. Collis GG, Cole CH, Le Souef PN. Dilution of nebulised aerosol by air entrainment in children. Lancet 1990;336:341-3.
22. Pham Thi Tuong N, Le Bourgeois M, de Blic J, et al. Inhaled treatment for asthma in practice. Arch Pediatr 2004;11:1377-83.
23. Wildhaber JH, Monkhoff M, Sennhauser FH. Dosage regimens for inhaled therapy in children should be reconsidered. J Paediatr Child Health 2002;38:115-6.
24. GINA Global Initiative for Asthma revised
2006. www.ginasthma.org.
25. British Guideline on the Management of Asthma. Revised edition November 2005
26. Newhouse MT. Are nebulizers obsolete for administering asthma medications to infant and children? Pediatric Pulm 1993;15: 271-2.
27. Sannier N, Timsit S, Cojocaru B, et al. Traitement aux urgences des crises d’asthme par nébulization vs chambers d’inhalation. Archives de Pédiatrie 2006;13:238-44.
28. Radzik D, Peroni DG, Pescollderungg L, et al. Nebulizers or Pressurized Metered- Dose Inhalers in the treatment of asthma exacerbations. Allergy and Asthma Proc 2005;26:207-9.
29. Rubin BK, Nakanishi AK, Lamb BM, et al. Dose equivalence of salbutamol given by metered dose aerosol with Aerochamber or by wet nebulization in children with stable asthma.(abstract) Eur Resp J 1993;6:353S.
30. Radzik D, Alberelli MC, Matteoli G, Pavanello L. Indagine sul gradimento di due metodiche per l’effettuazione della terapia aerosolica nell’attacco acuto d’asma dei bambini: spray più distanziatore verso nebulizzatore. Immunol Allergol Ped 2004;28:8-11.
31. Dolovich MB, Ahrens RC, Hess DR, et al. Device selection and outcomes of aerosol Therapy: Evidence Based Guidelines. Chest 2005;127:335-71.
32. Owayed A, Al-AteeqiW, Behbehani N. Proficiency of paediatricians in the use of inhaled medication delivery system for the management of asthma. J Asthma 2006;43: 459-62.
33. Chaney G, Clements B, Landau L. A new asthma spacer device to improve compliance in children: a pilot study. Respirology 2004;9: 499-506.
34. Marguet C, Couderc L, Le Roux P, et al. Inhalation treatment: Errors in application and difficulties in acceptance of the devices are frequent in wheezy infants and young children. Pediatr Allergy Immunol 2001;12: 224-30.
35. Wildhaber JH, Dore ND, Wilson JM, et al. Inhalation therapy in asthma: nebuliser or pressurized metered-dose inhaler with holding chamber? In vivo comparison of lung deposition in children. J Pediatr 1999;135:28-33.
36. Tal A, Golan H, Grauer N, et al. Deposition pattern of radiolabeled salbutamol inhaled from a metered - dose inhaler by means of a spacer with mask in young children with airway obstruction. J Pediatr 1996;128:479-84.
37. Janssens H, van der Wiel EC, Verbraak AF, et al. Aerosol therapy and the fighting toddler: is administration during sleep an alternative? J Aerosol Med 2003;16:395-400.
38. Esposito-Festen J, Ijssejstijn H, Hop W. Aerosol Therapy by Pressured Metered-Dose Inahler-Spacer in sleeping young children: To do or not to do? Chest 2006;130: 487-92.
39. Fitzgerald JM, Gibson PG. Asthma exacerbation 4: Prevention. Thorax 2006;61:992-9.
40. Crompton GK, Barnes PJ. Aerosol Delivery Devices. Chest 2006;129:1388-9.
41. Kamps AWA, Brand PLP, Roorda RJ. Determinants of correct inhalation technique in children attending a hospital-based asthma clinic. Acta Paediatr 2002;91:159-63.
42. Minai BA, Martin JE, Cohn RC. Results of a physician and respiratory therapist collaborative effort to improve long-term Metered- Dose Inhaler technique in a pediatric asthma clinic. Respir Care 2004;49:600-5.
43. Vierucci A, Novembre E. Le malattie allergiche. In: Schwarz Tiene, Manuale di Pediatria, 1997, pag. 957.
2. Crompton GK. Inhaler technique blind spot. Eur Respir J 2006;27:1070-1.
3. Battistini A. Come attuare al meglio la terapia aerosolica. Parte 1: Le metodiche. Ped Med Chir 1995;17:97-103.
4. Battistini A. Come attuare al meglio la terapia aerosolica. Parte 2: I farmaci. Ped Med Chir 1995;17:189-96.
5. Leung K, Louca E, Coates AL. Comparison of breath-enhanced to breath-actuated nebulizers for rate, consistency, and efficiency. Chest 2004;126:1619-27.
6. Amirav I, Balanov I, et al. Nebuliser hood compared to mask in wheezy infants. Arch Dis Child 2003;88:719-23.
7. Rodrigo GJ. Delivery of b-agonists in the emergency department setting. Chest 2005; 127:1890.
8. Rivera ML, Kim TV, Stewart GM. Albuterol nebulized in heliox in the initial ED treatment of pediatric asthma: a blinded, randomized controlled trial. Am J Emerg Med 2006;24:38-42.
9. Battistini A. Terapia inalatoria: come. Pneumorama 1997;3;14-21.
10. Roller CM, Zhang G, Troedson RG, et al. Spacer inhalation technique and deposition of extrafine aerosol in asthmatic children. Eur Respir J 2006 (Epub ahead of print).
11. Hess DR. Metered-Dose Inhalers and Dry Powder Inhalers in aerosol therapy. Respiratory Care 2005;50:1376-82.
12. Rubin BK. What does it mean when a patient says, “my asthma medication is not working?” Chest 2004;126:972-81.
13. Roller CM, Zhang G, Troedson RG. Spacer inhalation technique and deposition of extrafine aerosol in asthmatic children. Eur Respir J 2007;29:299-306.
14. Lipworth BJ, Sims EJ, Taylor K, et al. Dose- response to salbutamol via a novel palm sized nebuliser (Aerodose Inhaler), conventional nebuliser (Pari LC Plus) and metered dose inhaler (Ventolin Evohaler) in moderate to severe asthmatics. Br J Clin Pharmacol 2005;59:5-13.
15. Hayden JT, Smith N, Woolf DA, et al. A randomised crossover trial of face mask efficacy. Arch Dis Child 2004;89:72-3.
16. Rastogi D, Shetty A, Neugebauer R, et al. National Heart, Lung and Blood Institute Guidelines and asthma management practice among inner-city pediatric primary care providers. Chest 2006;129:619-23.
17. Chaney G, Clements B, Landau L. A new asthma spacer device to improve compliance in children: a pilot study. Respirology 2004,9:499-506.
18. Amirav I. Treatment failure in children with asthma due to inappropriate use of Turbohaler. J Pediatr 2002;140:483.
19. Cochrane MG, Mohan VB, Downs KE, et al. Inhaled corticosteroids for asthma therapy. Patients compliance, device and inhalation technique. Chest 2000;117:542-50.
20. Taylor DR, Iijnenburg MW, Smith AD. Exhaled nitric oxide measurement: clinical application and interpretation. Thorax 2006; 61:817-27.
21. Collis GG, Cole CH, Le Souef PN. Dilution of nebulised aerosol by air entrainment in children. Lancet 1990;336:341-3.
22. Pham Thi Tuong N, Le Bourgeois M, de Blic J, et al. Inhaled treatment for asthma in practice. Arch Pediatr 2004;11:1377-83.
23. Wildhaber JH, Monkhoff M, Sennhauser FH. Dosage regimens for inhaled therapy in children should be reconsidered. J Paediatr Child Health 2002;38:115-6.
24. GINA Global Initiative for Asthma revised
2006. www.ginasthma.org.
25. British Guideline on the Management of Asthma. Revised edition November 2005
26. Newhouse MT. Are nebulizers obsolete for administering asthma medications to infant and children? Pediatric Pulm 1993;15: 271-2.
27. Sannier N, Timsit S, Cojocaru B, et al. Traitement aux urgences des crises d’asthme par nébulization vs chambers d’inhalation. Archives de Pédiatrie 2006;13:238-44.
28. Radzik D, Peroni DG, Pescollderungg L, et al. Nebulizers or Pressurized Metered- Dose Inhalers in the treatment of asthma exacerbations. Allergy and Asthma Proc 2005;26:207-9.
29. Rubin BK, Nakanishi AK, Lamb BM, et al. Dose equivalence of salbutamol given by metered dose aerosol with Aerochamber or by wet nebulization in children with stable asthma.(abstract) Eur Resp J 1993;6:353S.
30. Radzik D, Alberelli MC, Matteoli G, Pavanello L. Indagine sul gradimento di due metodiche per l’effettuazione della terapia aerosolica nell’attacco acuto d’asma dei bambini: spray più distanziatore verso nebulizzatore. Immunol Allergol Ped 2004;28:8-11.
31. Dolovich MB, Ahrens RC, Hess DR, et al. Device selection and outcomes of aerosol Therapy: Evidence Based Guidelines. Chest 2005;127:335-71.
32. Owayed A, Al-AteeqiW, Behbehani N. Proficiency of paediatricians in the use of inhaled medication delivery system for the management of asthma. J Asthma 2006;43: 459-62.
33. Chaney G, Clements B, Landau L. A new asthma spacer device to improve compliance in children: a pilot study. Respirology 2004;9: 499-506.
34. Marguet C, Couderc L, Le Roux P, et al. Inhalation treatment: Errors in application and difficulties in acceptance of the devices are frequent in wheezy infants and young children. Pediatr Allergy Immunol 2001;12: 224-30.
35. Wildhaber JH, Dore ND, Wilson JM, et al. Inhalation therapy in asthma: nebuliser or pressurized metered-dose inhaler with holding chamber? In vivo comparison of lung deposition in children. J Pediatr 1999;135:28-33.
36. Tal A, Golan H, Grauer N, et al. Deposition pattern of radiolabeled salbutamol inhaled from a metered - dose inhaler by means of a spacer with mask in young children with airway obstruction. J Pediatr 1996;128:479-84.
37. Janssens H, van der Wiel EC, Verbraak AF, et al. Aerosol therapy and the fighting toddler: is administration during sleep an alternative? J Aerosol Med 2003;16:395-400.
38. Esposito-Festen J, Ijssejstijn H, Hop W. Aerosol Therapy by Pressured Metered-Dose Inahler-Spacer in sleeping young children: To do or not to do? Chest 2006;130: 487-92.
39. Fitzgerald JM, Gibson PG. Asthma exacerbation 4: Prevention. Thorax 2006;61:992-9.
40. Crompton GK, Barnes PJ. Aerosol Delivery Devices. Chest 2006;129:1388-9.
41. Kamps AWA, Brand PLP, Roorda RJ. Determinants of correct inhalation technique in children attending a hospital-based asthma clinic. Acta Paediatr 2002;91:159-63.
42. Minai BA, Martin JE, Cohn RC. Results of a physician and respiratory therapist collaborative effort to improve long-term Metered- Dose Inhaler technique in a pediatric asthma clinic. Respir Care 2004;49:600-5.
43. Vierucci A, Novembre E. Le malattie allergiche. In: Schwarz Tiene, Manuale di Pediatria, 1997, pag. 957.
Corrispondenza: aubattistini@tiscali.it