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Review
. 2021 Apr;9(7):593.
doi: 10.21037/atm-20-1682.

A path to successful patient outcomes through aerosol drug delivery to children: a narrative review

Arzu Ari  1
Affiliations
Review

A path to successful patient outcomes through aerosol drug delivery to children: a narrative review

Arzu Ari. Ann Transl Med. 2021 Apr.

Abstract

Although using aerosolized medications is a mainstay of treatment in children with asthma and other respiratory diseases, there are many issues in terms of device and interface selection, delivery technique and dosing, as well as patient and parental education that have not changed for half a century. Also, due to many aerosol devices and interfaces available on the market and the broad range of patient characteristics and requirements, providing effective aerosol therapy to children becomes a challenge. While aerosol delivery devices are equally effective, if they are age-appropriate and used correctly, the majority of aerosol devices require multiple steps to be used efficiently. Unfortunately, many children with pulmonary diseases have problems with the correct delivery technique and do not gain therapeutic benefits from therapy that result in poor disease management and increased healthcare costs. Therefore, the purpose of this paper is to review the current knowledge on aerosol delivery devices used in children and guide clinicians on the optimum device- and interface-selection, delivery technique, and dosing in this patient population. Strategies on how to deliver aerosolized medications in crying and distressed children and how to educate parents on aerosol therapy and promote patient adherence to prescribed medications are also provided. Future directions of aerosol therapy in children should focus on these issues and implement policies and clinical practices that highlight the potential solutions to these problems.

Keywords: Aerosols; and children; facemask; high flow nasal cannula; inhalers; nebulizers.

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Conflict of interest statement

Conflicts of Interest: The author has completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/atm-20-1682). The series “Medical Aerosol in Acute and Critical Care” was commissioned by the editorial office without any funding or sponsorship. AA reports personal fees from Bayer Pharmaceuticals, personal fees from Sunovion Pharmaceuticals, grants and personal fees from Aerogen Ltd., Grants from ARC Medical, outside the submitted work. The author has no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
A screening tool for aerosol device selection in children based on child's age, hand-breath coordination, and inspiratory flow.
Figure 2
Figure 2
Recommendations concerning interface selection based on the type of aerosol device.
Figure 3
Figure 3
Recommendations for interface selection based on the age of the patient.
Figure 4
Figure 4
Soother mask (reproduced with permission from InspiRx, Somerset, New Jersey).
See this image and copyright information in PMC

References

    1. van Aalderen WM, Garcia-Marcos L, Gappa M, et al. How to match the optimal currently available inhaler device to an individual child with asthma or recurrent wheeze. NPJ Prim Care Respir Med 2015;25:14088. 10.1038/npjpcrm.2014.88 - DOI - PMC - PubMed
    1. Goralski JL, Davis SD. Breathing easier: addressing the challenges of aerosolizing medications to infants and preschoolers. Respir Med 2014;108:1069-74. 10.1016/j.rmed.2014.06.004 - DOI - PubMed
    1. Ari A, Fink JB. Recent advances in aerosol devices for the delivery of inhaled medications. Expert Opin Drug Deliv 2020;17:133-44. 10.1080/17425247.2020.1712356 - DOI - PubMed
    1. Yilmaz O, Sogut A, Kose U, et al. Influence of ambulatory inhaled treatment with different devices on the duration of acute asthma findings in children. J Asthma 2009;46:191-3. 10.1080/02770900802604137 - DOI - PubMed
    1. Alvine GF, Rodgers P, Fitzsimmons KM, et al. Disposable jet nebulizers. How reliable are they? Chest 1992;101:316-9. 10.1378/chest.101.2.316 - DOI - PubMed

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