Inhalation therapy in children: new opportunities
https://doi.org/10.18093/0869-0189-2019-29-4-499-507
Abstract
Inhalation therapy is widely used for treatment of acute respiratory infections and asthma in children, and provides more rapid drug delivery in the airways. Treatment success in children with respiratory diseases is defined not only by an adequate choice of the drug and the dosage regimen, but also by inhalation drug delivery system. The choice of drug delivery device in children depends on the child's age and ability to carry out instructions related to the inhalation technique. Incorrect inhalation technique is associated with inappropriate distribution of the drug in the respiratory tract and an unreasonable increase in the volume of therapy, risk of adverse effects, and the total cost of the treatment. Currently, a great number of various drug delivery systems are commercially available, such as a pressurised metered dose inhaler (MDI), a MDI with spacer and facemask, a dry powder inhaler, and a nebulizer. The most optimal inhalation drug delivery device for children is a nebulizer. In this article, the authors discussed benefits and limitations of various drug delivery systems and modern nebulizers used for treatment of the upper and the lower airways including DuoBaby nebulizer 2-in-1 with a nasal aspirator.
About the Authors
Е. Е. LokshinaRussian Federation
Evelina E. Lokshina, Candidate of Medicine, Associate Professor, Department of Pediatrics
ul. Delegatskaya 20, build. 1, Moscow, 127473
О. V. Zaytseva
Russian Federation
Ol’ga V. Zaytseva, Doctor of Medicine, Professor, Head of Department of Pediatrics
ul. Delegatskaya 20, build. 1, Moscow, 127473
References
1. Lokshina E.E., Zaytseva O.V., Zaytseva S.V. [Inhalation therapy of respiratory diseases in children]. Atmosfera. Pul'monologiya i allergologiya. 2012; (4): 41–45 (in Russian).
2. Zakharova I.N., Kas'yanova A.N., Klimov L.Ya. et al. [Respiratory tract microbiome: what is known today?]. Pediatriya (Suppl. Consilium Medicum). 2018; (4): 10–17. DOI: 10.26442/24138460.2018.4.180129 (in Russian).
3. Dickson R.P., Erb-Downward J.R., Freeman C.M. et al. Spatial variation in the healthy human lung microbiome and the adapted island model of lung biogeography. Ann. Am. Thorac. Soc. 2015; 12 (6): 821–830. DOI: 10.1513/AnnalsATS.201501-029OC.
4. Bassis C.M., Erb-Downward J.R., Dickson R.P. et al. Analysis of the upper respiratory tract microbiotas as the source of the lung and gastric microbiotas in healthy individuals. MBio. 2015; 6 (2): e00037. DOI: 10.1128/mBio.00037-15.
5. Charlson E.S., Bittinger K, Haas A.R. et al. Topographical continuity of bacterial populations in the healthy human respiratory tract. Am. J. Respir. Crit. Care Med. 2011; 184 (8): 957–963. DOI: 10.1164/rccm.201104-0655OC.
6. Prevaes S.M., de Winter-de Groot K.M., Janssens H.M. et al. Development of the nasopharyngeal microbiota in infants with cystic fibrosis. Am. J. Respir. Crit. Care Med. 2016; 193 (5): 504–515. DOI: 10.1164/rccm.201509-1759OC.
7. Hoen A.G., Li J, Moulton L.A. et al. Associations between gut microbial colonization in early life and respiratory outcomes in cystic fibrosis. J. Pediatr. 2015; 167 (1): 138–147. e1–3. DOI: 10.1016/j.jpeds.2015.02.049.
8. Zaytseva S.V., Snitko S.Yu., Zaytseva O.V., Lokshina E.E. [Treatment of acute bronchial obstruction in children with acute respiratory diseases]. Lechashchiy vrach. 2013; (11): 50–55 (in Russian).
9. Zaytseva O.V. [Acute airway obstruction in children]. Atmosfera. Pul'monologiya i allergologiya. 2005; (2): 6–10 (in Russian).
10. Zaytseva O.V. [Bronchial obstruction in children]. Pediatriya. 2005; 84 (4): 94–104 (in Russian).
11. Simonova O.I., Gorinova Yu.V., Alekseeva A.A., Tomilova A.Yu. [Bronchial obstruction in children: a new solution to an old problem]. Voprosy sovremennoy pediatrii. 2015; 14 (2): 276–280 (in Russian).
12. Brand P.L., Caudri D., Eber E. et al. Classification and pharmacological treatment of preschool wheezing: changes since 2008. Eur. Respir. J. 2014; 43 (4): 1172–1177. DOI: 10.1183/09031936.00199913.
13. Muers M.F. Overview of nebulizer treatment. Thorax. 1997; 52 (Suppl. 2): S25–30. DOI: 10.1136/thx.52.2008.s25.
14. Zaytseva O.V., Zaytseva S.V. [Nebulizers for treatment of respiratory diseases in children]. Russkiy meditsinskiy zhurnal. 2013; 21 (25): 1228–1232 (in Russian).
15. Bronchial Asthma in Children. A Strategy of Treatment and Prevention. A National Programme. 5th Revised and Enlarged Edition. Moscow: Original-maket; 2017 (in Russian).
16. Downs K.E. et al. Inhaled corticosteroids for asthma therapy: patient compliance, devices, and inhalation technique. Chest. 2000; 117 (2): 542–550. DOI: 10.1378/chest.117.2.542.
17. Zaytseva S.V., Lavrent'ev A.V., Zaytseva. O.V. [Aerosolized therapy of bronchial asthma in children]. Lechashchiy vrach. 2000; (3): 28–31 (in Russian).
18. Zhestkov A.V., Svetlova G.N., Kosov A.I. [Short-acting b2-agonists: mechanisms of action and pharmacological therapy of asthma and chronic obstructive pulmonary disease]. Consilium Medicum. 2008; 10 (3): 99–103 (in Russian).
19. Fisenko V.P., Chichkova N.V. [Current pharmacological therapy of bronchial asthma]. Vrach. 2006; (1): 56–60 (in Russian).
20. Giraud V., Roche N. Misuse of corticosteroid metered-dose inhaler is associated with decreased asthma stability. Eur. Respir. J. 2002; 19 (2): 246–251. DOI: 10.1183/09031936.02.00218402.
21. Schueepp K.G., Devadason S.G., Roller C. et al. Aerosol delivery of nebulised budesonide in young children with asthma. Respir. Med. 2009; 103 (11): 1738–1745. DOI: 10.1016/j.rmed.2009.04.029.
22. Laube B.L., Janssens H.M., de Jongh F.H. et al. What the pulmonary specialist should know about the new inhalation therapies. Eur. Respir. J. 2011; 37 (6): 1308–1407. DOI: 10.1183/09031936.00166410.
23. Avdeev S.N. [A new generation of nebulizers]. Meditsinskiy alfavit. 2010; 1–2 (8): 30–34 (in Russian).
24. Chonmaitree T., Revai K., Grady J.J. et al. Viral upper respiratory tract infection and otitis media complication in young children. Clin. Infect. Dis. 2008; 46 (6): 815–823. DOI: 10.1086/528685.
25. Revai K., Dobbs L.A., Nair S. et al. Incidence of acute otitis media and sinusitis complicating upper respiratory tract infection: the effect of age. Pediatrics. 2007; 119 (6): e1408–1412. DOI: 10.1542/peds.2006-2881.
26. Licari A., Brambilla I., De Filippo M. et al. The role of upper airway pathology as a co-morbidity in severe asthma. Exp. Rev. Respir. Med. 2017; 11 (11): 855–865. DOI: 10.1080/17476348.2017.1381564.
27. Kohli N., DeCarlo D., Goldstein N.A., Silverman J. Asthma outcomes after adenotonsillectomy: a systematic review. Int. J. Pediatr. Otorhinolaryngol. 2016; 90: 107–112. DOI: 10.1016/j.ijporl.2016.08.030.
28. Compalati E., Ridolo E., Passalacqua G. et al. The link between allergic rhinitis and asthma: the united airways disease. Exp. Rev. Clin. Immunol. 2010; 6 (3): 413–423. DOI: 10.1586/eci.10.15.
29. Bousquet J., Khaltaev N., Cruz A.A. et al. Allergic rhinitis and its impact on asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy. 2008; 63 (Suppl. 86): 8–160. DOI: 10.1111/j.1398-9995.2007.01620.x.
30. Bousquet J., Addis A., Adcock I. et al. Integrated care pathways for airway diseases (AIRWAYS-ICPs). Eur. Respir. J. 2014; 44 (2): 304–323. DOI: 10.1183/09031936.00014614.
31. Giavina-Bianchi P., Aun M.V., Takejima P. et al. United airway disease: current perspectives. J. Asthma Allergy. 2016; 9: 93–100. DOI: 10.2147/JAA.S81541.
32. Chirico G., Quartarone G., Mallefet P. Nasal congestion in infants and children: a literature review on efficacy and safety of non-pharmacological treatments. Minerva Pediatr. 2014; 66 (6): 549–557.
33. Verger T.J., Verger E.E. Respiratory syncytial virus bronchiolitis in children. Crit. Care Nurs. Clin. North Am. 2012; 24 (4): 555–572. DOI: 10.1016/j.ccell.2012.07.008.
34. Roberts G., Xatzipsalti M., Borrego L.M. et al. Paediatric rhinitis: position paper of the European Academy of Allergy and Clinical Immunology. Allergy. 2013; 68 (9): 1102–1116. DOI: 10.1111/all.12235.
35. Casati M., Picca M., Marinello R., Quartarone G. Safety of use, efficacy and degree of parental satisfaction with the nasal aspirator Narhinel in the treatment of nasal congestion in babies. Minerva Pediatr. 2007; 59 (4): 315–325.
36. Montanari G., Ceschin F., Masotti S. et al. Observational study on the performance of the Narhinel method (nasal aspirator and physiological saline solution) versus physiological saline solution in the prevention of recurrences of viral rhinitis and associated complications of the upper respiratory tract infections (URTI), with a special focus on acute rhinosinusitis and acute otitis of the middle ear. Minerva Pediatr. 2010; 62 (1): 9–21.
37. Pizzulli A., Perna S., Bennewiz A. et al. The impact of nasal aspiration with an automatic device on upper and lower respiratory symptoms in wheezing children: a pilot case-control study. Ital. J. Pediatr. 2018; 44 (1): 68. DOI: 10.1186/s13052-018-0489-6.
Review
For citations:
Lokshina Е.Е., Zaytseva О.V. Inhalation therapy in children: new opportunities. PULMONOLOGIYA. 2019;29(4):499-507. (In Russ.) https://doi.org/10.18093/0869-0189-2019-29-4-499-507