Nebulization therapy for asthma: A practical guide for the busy pediatrician

Clinical Pediatrics

Volumn 47, Issue 8, 2008, Pages 744-756

  Welch, Michael J ^a,b  

^a ALLERGY AND ASTHMA MEDICAL GROUP AND RESEARCH CENTER   (United States)

^b UNIVERSITY OF CALIFORNIA SAN DIEGO   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ACCUNEB; BECLOMETASONE; BETA 2 ADRENERGIC RECEPTOR STIMULATING AGENT; BRONCHODILATING AGENT; BUDESONIDE; CHOLINERGIC RECEPTOR BLOCKING AGENT; CORTICOSTEROID DERIVATIVE; CROMOGLYCATE DISODIUM; FLUTICASONE PROPIONATE; IPRATROPIUM BROMIDE; LEVALBUTEROL; ORCIPRENALINE; SALBUTAMOL; SALBUTAMOL SULFATE; UNCLASSIFIED DRUG; XONOPENEX;

ASTHMA; BREATHING PATTERN; CLINICAL TRIAL; DISEASE EXACERBATION; DRUG DELIVERY SYSTEM; DRUG EFFICACY; DRUG SAFETY; HUMAN; NEBULIZATION; NEBULIZER; PATIENT EDUCATION; PEDIATRICIAN; PORTABLE EQUIPMENT; PRACTICE GUIDELINE; REVIEW; WHEEZING;

ADRENERGIC BETA-AGONISTS; ANTI-ASTHMATIC AGENTS; ASTHMA; CHILD; CHILD, PRESCHOOL; EQUIPMENT DESIGN; HUMANS; NEBULIZERS AND VAPORIZERS;

EID: 50949130252     PISSN: 00099228     EISSN: None     Source Type: Journal    
DOI: 10.1177/0009922808316188     Document Type: Review

References (101)

1. O'Callaghan C., Barry PW How to choose delivery devices for asthma. Arch Dis Child. 2000 ; 82: 185-191.
2. Berger WE Paediatric pulmonary drug delivery: considerations in asthma treatment. Expert Opin Drug Deliv. 2005 ; 2: 965-980.
3. De Benedictis FM, Selvaggio D. Use of inhaler devices in pediatric asthma. Paediatr Drugs. 2003 ; 5: 629-638.
4. American Academy of Allergy Asthma and Immunology and American Academy of Pediatrics. Pediatric asthma promoting best practice: guide for managing asthma in children. 2004. American Academy of Allergy Asthma and Immunology. http://www.aaaai.org/members/resources/initiatives/pediatricasthma.stm. Accessed January 17, 2007.
5. Dolovich MB, Ahrens RC, Hess DR,, et al. for American College of Chest Physicians and the American College of Asthma, Allergy, and Immunology. Device selection and outcomes of aerosol therapy: evidence-based guidelines. Chest. 2005 ; 127: 335-371.
6. Welch MJ, Smaldone GC Effective use of nebulizer systems in pediatric asthma therapy. Adv Phys Assist. 2002 ; 10: 52.
7. Larsen JS, Hahn M., Ekholm B., Wick KA Evaluation of conventional press-and-breathe metered-dose inhaler technique in 501 patients. J Asthma. 1994 ; 31: 193-199.
8. Kamps AW, van Ewijk B., Roorda RJ, Brand PL Poor inhalation technique, even after inhalation instructions, in children with asthma. Pediatr Pulmonol. 2000 ; 29: 39-42.
9. Crompton GK Problems patients have using pressurized aerosol inhalers. Eur J Respir Dis Suppl. 1982 ; 119: 101-104.
10. De Blaquiere P., Christensen DB, Carter WB, Martin TR Use and misuse of metered-dose inhalers by patients with chronic lung disease. A controlled, randomized trial of two instruction methods. Am Rev Respir Dis. 1989 ; 140: 910-916.
11. Szefler SJ Clinical need for a nebulized corticosteroid. J Allergy Clin Immunol. 1999 ; 104: 162S - 168S.
12. Pedersen S. Inhalers and nebulizers: which to choose and why. Respir Med. 1996 ; 90: 69-77.
13. American Academy of Allergy Asthma and Immunology. Allergy and asthma medication guide: inhaled corticosteroids. http://www.aaaai.org/patients/ resources/medication_guide/inhaledcorticosteroidstable.stm. Accessed December 4, 2006.
14. National Asthma Education and Prevention Program. Expert panel report: guidelines for the diagnosis and management of asthma-update on selected topics 2002. J Allergy Clin Immunol. 2002 ; 110 (suppl): 141S - 219S.
15. Alupent® (metaproterenol sulfate) [prescribing information]. Ridgefield, CT: Boehringer Ingelheim Pharmaceuticals Inc ; 2005.
16. Robertson CF, Norden MA, Fitzgerald DA, et al. Treatment of acute asthma: salbutamol via jet nebuliser vs spacer and metered dose inhaler. J Paediatr Child Health. 1998 ; 34: 142-146.
17. Castro-Rodriguez JA, Rodrigo GJ β-agonists through metered-dose inhaler with valved holding chamber versus nebulizer for acute exacerbation of wheezing or asthma in children under 5 years of age: a systematic review with meta-analysis. J Pediatr. 2004 ; 145: 172-177.
18. Batra V., Sethi GR, Sachdev HPS. Comparative efficacy of jet nebulizer and metered dose inhaler with spacer device in the treatment of acute asthma. Indian Pediatr. 1997 ; 34: 497-503.
19. Chou KJ, Cunningham SJ, Crain EF Metered-dose inhalers with spacers vs nebulizers for pediatric asthma. Arch Pediatr Adolesc Med. 1995 ; 149: 201-205.
20. Closa RM, Ceballos JM, Gómez-Papí A., Galiana AS, Gutiérrez C., Martí-Henneber C. Efficacy of bronchodilators administered by nebulizers versus spacer devices in infants with acute wheezing. Pediatr Pulmonol. 1998 ; 26: 344-348.
21. Cates CJ, Crilly JA, Rowe BH Holding chambers (spacers) versus nebulisers for beta-agonist treatment of acute asthma. Cochrane Database Syst Rev. 2006 ;(2). CD000052. doi: 10.1002/14651858.CD000052.pub2.
22. Delgado A., Chou KJ, Silver EJ, Crain EF Nebulizers vs metered-dose inhalers with spacers for bronchodilator therapy to treat wheezing in children aged 2 to 24 months in a pediatric emergency department. Arch Pediatr Adolesc Med. 2003 ; 157: 76-80.
23. Dewar AL, Stewart A., Cogswell JJ, Connett GJ A randomised controlled trial to assess the relative benefits of large volume spacers and nebulisers to treat acute asthma in hospital. Arch Dis Child. 1999 ; 80: 421-423.
24. Korem E., Levison H., Schuh S., et al. Efficacy of albuterol administered by nebulizer versus spacer device in children with acute asthma. J Pediatr. 1993 ; 123: 313-317.
25. Leversha AM, Campanella SG, Aickin RP, Asher MI Costs and effectiveness of spacer versus nebulizer in young children with moderate and severe acute asthma. J Pediatr. 2000 ; 136: 497-502.
26. Mandelberg A., Tsehori S., Houri S., Gilad E., Morag B., Priel IE Is nebulized aerosol treatment necessary in the pediatric emergency department? Comparison with a metal spacer device for metered-dose inhaler. Chest. 2000 ; 117: 1309-1313.
27. Ploin D., Chapuis FR, Stamm D., et al. High-dose albuterol by metered-dose inhaler plus a spacer device versus nebulization in preschool children with recurrent wheezing: a double-blind, randomized equivalence trial. Pediatrics. 2000 ; 106: 311-317.
28. Rubilar L., Castro-Rodriguez JA, Girardi G. Randomized trial of salbutamol via metered-dose inhaler with spacer versus nebulizer for acute wheezing in children less than 2 years of age. Pediatr Pulmonol. 2000 ; 29: 264-269.
29. Schuh S., Johnson DW, Stephens D., Callahan S., Winders P., Canny GJ Comparison of albuterol delivered by a metered dose inhaler with spacer versus a nebulizer in children with mild acute asthma. J Pediatr. 1999 ; 135: 22-27.
30. Williams JR, Bothner JP, Swanton RD Delivery of albuterol in a pediatric emergency department. Pediatr Emerg Care. 1996 ; 12: 263-267.
31. Lin YZ, Hsieh KH Metered dose inhaler and nebuliser in acute asthma. Arch Dis Child. 1995 ; 72: 214-218.
32. O'Reilly JF, Weir DC, Banham S., Basran GS, Boyd G., Patel KR Is high-dose fluticasone propionate via a metered-dose inhaler and Volumatic™ as efficacious as nebulized budesonide in adult asthmatics? Respir Med. 1998 ; 92: 111-117.
33. Bisgaard H., Nikander K., Munch E. Comparative study of budesonide as a nebulized suspension vs pressurized metered-dose inhaler in adult asthmatics. Respir Med. 1998 ; 92: 44-49.
34. Guilbert TW, Morgan WJ, Zeiger RS, et al. Long-term inhaled corticosteroids in preschool children at high risk for asthma. N Engl J Med. 2006 ; 354: 1985-1997.
35. Teper AM, Kofman CD, Szulman GA, Vidaurreta SM, Maffey AF Fluticasone improves pulmonary function in children under 2 years old with risk factors for asthma. Am J Respir Crit Care Med. 2005 ; 171: 587-590.
36. Wasserman RL, Baker JW, Kim KT, et al. Efficacy and safety of inhaled fluticasone propionate chlorofluorocarbon in 2- to 4-year-old patients with asthma: results of a double-blind, placebo-controlled study. Ann Allergy Asthma Immunol. 2006 ; 96: 808-818.
37. Bisgaard H., Allen D., Milanowski J., Kalev I., Willits L., Davies P. Twelve-month safety and efficacy of inhaled fluticasone propionate in children aged 1 to 3 years with recurrent wheezing. Pediatrics. 2004 ; 113: 87-94.
38. Bisgaard H., Gillies J., Groenewald M., Maden C. ; for an International Study Group. The effect of inhaled fluticasone propionate in the treatment of young asthmatic children. A dose comparison study. Am J Respir Crit Care Med. 1999 ; 160: 126-131.
39. Lødrup Carlsen KC, Stick S., Kamin W., Cirule I., Hughes S., Wixon C. The efficacy and safety of fluticasone propionate in very young children with persistent asthma symptoms. Respir Med. 2005 ; 99: 1393-1402.
40. Berger WE, Shapiro GG The use of inhaled corticosteroids for persistent asthma in infants and young children. Ann Allergy Asthma Immunol. 2004 ; 92: 387-400.
41. Agertoft L., Andersen A., Weibull E., Pedersen S. Systemic availability and pharmacokinetics of nebulised budesonide in preschool children. Arch Dis Child. 1999 ; 80: 241-247.
42. Lødrup Carlsen KC, Nikander K., Carlsen KH How much nebulised sudesonide reaches infants and toddlers ? Arch Dis Child. 1992 ; 67: 1077-1079.
43. Baker JW, Mellon M., Wald J., Welch M., Cruz-Rivera M., Walton-Bowen K. A multiple-dosing, placebo-controlled study of budesonide inhalation suspension given once or twice daily for treatment of persistent asthma in young children and infants. Pediatrics. 1999 ; 103: 414-421.
44. Berger WE, Qaqundah PY, Blake K., et al. Safety of budesonide inhalation suspension in infants aged six to twelve months with mild to moderate persistent asthma or recurrent wheeze. J Pediatr. 2005 ; 146: 91-95.
45. De Blic J., Delacourt C., Le Bourgeois M., et al. Efficacy of nebulized budesonide in treatment of severe infantile asthma: a double-blind study. J Allergy Clin Immunol. 1996 ; 98: 14-20.
46. Irani AM, Cruz-Rivera M., Fitzpatrick S., Hoag J., Smith JA Effects of budesonide inhalation suspension on hypothalamic-pituitary-adrenal-axis function in infants and young children with persistent asthma. Ann Allergy Asthma Immunol. 2002 ; 88: 306-312.
47. Kemp JP, Skoner DP, Szefler SJ, Walton-Bowen K., Cruz-Rivera M., Smith JA Once-daily budesonide inhalation suspension for the treatment of persistent asthma in infants and young children. Ann Allergy Asthma Immunol. 1999 ; 83: 231-239.
48. Leflein JG, Gawchik SM, Galant SP, et al. Safety of budesonide inhalation suspension (Pulmicort Respules) after up to 52 weeks of treatment in infants and young children with persistent asthma. Allergy Asthma Proc. 2001 ; 22: 359-366.
49. Leflein JG, Szefler SJ, Murphy KR, et al. Nebulized budesonide inhalation suspension compared with cromolyn sodium nebulizer solution for asthma in young children: results of a randomized outcomes trial. Pediatrics. 2002 ; 109: 866-872.
50. Szefler SJ, Lyzell E., Fitzpatrick S., Cruz-Rivera M. Safety profile of budesonide inhalation suspension in the pediatric population: worldwide experience. Ann Allergy Asthma Immunol. 2004 ; 93: 83-90.
51. Nikander K. Some technical, physicochemical and physiological aspects of nebulization of drugs. Eur Respir Rev. 1997 ; 7: 168-172.
52. Kendrick AH, Smith EC, Wilson RSE. Selecting and using nebuliser equipment. Thorax. 1997 ; 52 (suppl 2). 92S - 101S.
53. Muers MF The rational use of nebulisers in clinical practice. Eur Respir Rev. 1997 ; 7: 189-197.
54. O'Callaghan C., Barry PW The science of nebulised drug delivery. Thorax. 1997 ; 52 (suppl 2). 31S - 44S.
55. Nikander K. Drug delivery systems. J Aerosol Med. 1994 ; 7: 19S - 24S.
56. Leung K., Louca E., Coates AL Comparison of breath-enhanced to breath-actuated nebulizers for rate, consistency, and efficiency. Chest. 2004 ; 126: 1619-1627.
57. Denyer J., Nikander K., Smith NJ Adaptive aerosol delivery (AAD®) technology. Expert Opin Drug Deliv. 2004 ; 1: 165-176.
58. O'Callaghan C., White J., Jackson J., Barry PW, Kantar A. Delivery of nebulized budesonide is affected by nebulizer type and breathing pattern. J Pharm Pharmacol. 2005 ; 57: 787-790.
59. Barry PW, O'Callaghan C. An in vitro analysis of the output of budesonide from different nebulizers. J Allergy Clin Immunol. 1999 ; 104: 1168-1173.
60. Reisner C., Katial RK, Bartelson BB, Buchmeir A., Rosenwasser LJ, Nelson HS Characterization of aerosol output from various nebulizer/compressor combinations. Ann Allergy Asthma Immunol. 2001 ; 86: 566-574.
61. Hess D., Fisher D., Williams P., Pooler S., Kacmarek RM Medication nebulizer performance. Effects of diluent volume, nebulizer flow, and nebulizer brand. Chest. 1996 ; 110: 498-505.
62. Barry PW, O'Callaghan C. The output of budesonide from nebulisers. J Allergy Clin Immunol. 1998 ; 102: 321-322.
63. Smaldone GC, Cruz-Rivera M., Nikander K. In vitro determination of inhaled mass and particle distribution for budesonide nebulizing suspension. J Aerosol Med. 1998 ; 11: 113-125.
64. Pulmicort Respules® (budesonide inhalation suspension) [prescribing information]. Wilmington, DE: AstraZeneca LP ; 2007.
65. AccuNeb® (albuterol sulfate) inhalation solution [prescribing information]. Napa, CA: DEY ; 2005.
66. Medical News Today. PARI named leading nebulizer company in Cambridge consulting survey. http://www.medicalnewstoday.com/printerfriendlynews.php? newsid=45575. Accessed January 17, 2007.
67. Tobi® (tobramycin inhalation solution) [prescribing information]. Emeryville, CA: Chiron Corporation ; 2004.
68. Brovana™ (arformoterol tartrate) inhalation solution [prescribing information]. Marlborough, MA: Sepracor, Inc ; 2006.
69. Xopenex® (levalbuterol HCL) inhalation solution [prescribing information]. Marlborough, MA: Sepracor, Inc ; 2002.
70. Pallares DE, Pilarski BR, Rodriguez JL, Leickly FE A comparison of bronchodilator responses to albuterol delivered by ultrasonic versus jet nebulization in moderate to severe asthma. Ann Allergy Asthma Immunol. 1996 ; 77: 292-297.
71. Nakanishi AK, Lamb BM, Foster C., Rubin BK Ultrasonic nebulization of albuterol is no more effective than jet nebulization for the treatment of acute asthma in children. Chest. 1997 ; 111: 1505-1508.
72. Nikander K., Turpeinen M., Wollmer P. The conventional ultrasonic nebulizer proved inefficient in nebulizing a suspension. J Aerosol Med. 1999 ; 12: 47-53.
73. PARI Aerosol Research Institute. http://www.paripharma.com/technologies1. htm. Accessed February 8, 2007.
74. Berlinski A., Waldrep JC Nebulized drug admixtures: effect on aerosol characteristics and albuterol output. J Aerosol Med. 2006 ; 19: 484-490.
75. McKenzie JE, Cruz-Rivera M. Compatibility of budesonide inhalation suspension with four nebulizing solutions. Ann Pharmacother. 2004 ; 38: 967-972.
76. Kamin W., Schwabe A., Krämer I. Inhalation solutions- which one are allowed to be mixed? Physico-chemical compatibility of drug solutions in nebulizers. J Cyst Fibros. 2006 ; 5: 205-213.
77. Gruber C., Moenkhoff M., Hamacher J., Frey U., Sennhauser FH, Wildhaber JH The influence of a nose-clip on inhalation therapy in asthmatic children. Pediatr Asthma Allergy Immunol. 2003 ; 16: 129-135.
78. Lowenthal D., Kattan M. Facemasks versus mouthpieces for aerosol treatment of asthmatic children. Pediatr Pulmonol. 1992 ; 14: 192-196.
79. Georgitis JW, McWilliams B., Cruz-Rivera M., Fitzpatrick S., Smith JA Effective once-daily administration of budesonide inhalation suspension by nebulizer with facemasks or mouthpieces for persistent asthma in infants and young children. Pediatr Asthma Allergy Immunol. 2001 ; 15: 3-13.
80. Mellon M., Leflein J., Walton-Bowen K., Cruz-Rivera M., Fitzpatrick S., Smith JA Comparable efficacy of administration with face mask or mouthpiece of nebulized budesonide inhalation suspension for infants and young children with persistent asthma. Am J Respir Crit Care Med. 2000 ; 162: 593-598.
81. Rubin BK Nebulizer therapy for children: the device-patient interface. Respir Care. 2002 ; 47: 1314-1319.
82. Everard ML, Clark AR, Milner AD Drug delivery from jet nebulisers. Arch Dis Child. 1992 ; 67: 586-591.
83. Restrepo RD, Dickson SK, Rau JL, Gardenshire DS An investigation of nebulized bronchodilator delivery using a pediatric lung model of spontaneous breathing. Respir Care. 2006 ; 51: 56-61.
84. Iles R., Lister P., Edmunds AT Crying significantly reduces absorption of aerosolized drug in infants. Arch Dis Child. 1999 ; 81: 163-165.
85. Murakami G., Igarashi T., Adachi Y., et al. Measurement of bronchial hyperreactivity in infants and preschool children using a new method. Ann Allergy. 1990 ; 64: 383-387.
86. Standaert TA, Morlin GL, Williams-Warren J., et al. Effects of repetitive use and cleaning techniques of disposable jet nebulizers on aerosol generation. Chest. 1998 ; 114: 577-586.
87. Merkus PJ, van Essen-Zandvliet EE, Parlevliet E., et al. Changes of nebulizer output over the years. Eur Respir J. 1992 ; 5: 488-491.
88. Tablan OC, Anderson LJ, Arden NH, Breiman RF, Butler JC, McNeil MM ; for Hospital Infection Control Practices Advisory Committee and the Centers for Disease Control and Prevention. Guideline for prevention of nosocomial pneumonia. Am J Infect Control. 1994 ; 22: 247-292.
89. Craven DE, Lichtenberg DA, Goularte TA, Make BJ, McCabe WR Contaminated medication nebulizers in mechanical ventilator circuits. Source of bacterial aerosols. Am J Med. 1984 ; 77: 834-838.
90. Hamill RJ, Houston ED, Georghiou PR, et al. An outbreak of Burkholderia (formerly Pseudomonas) cepacia respiratory tract colonization and infection associated with nebulized albuterol therapy. Ann Intern Med. 1995 ; 122: 762-766.
91. Oie S., Makieda D., Ishida S., Okano Y., Kamiya A. Microbial contamination of nebulization solution and its measures. Biol Pharm Bull. 2006 ; 29: 503-507.
92. Everard ML Inhaler devices in infants and children: challenges and solutions. J Aerosol Med. 2004 ; 17: 186-195.
93. Schöni MH, Horak E., Nikolaizik WH Compliance with therapy in children with respiratory diseases. Eur J Pediatr. 1995 ; 154 (suppl 3). 77S - 81S.
94. Iqbal S., Ritson S., Prince I., Denyer J., Everard ML Drug delivery and adherence in young children. Pediatr Pulmonol. 2004 ; 37: 311-317.
95. Cochrane MG, Bala MV, Downs KE, Mauskopf J., Ben-Joseph RH Inhaled corticosteroids for asthma therapy. Patient compliance, devices, and inhalation technique. Chest. 2000 ; 117: 542-550.
96. Rau JL Determinants of patient adherence to an aerosol regimen. Respir Care. 2005 ; 50: 1346-1356.
97. Graves MM, Adams CD, Portnoy JM Adherence in young children with asthma. Curr Opin Allergy Clin Immunol. 2006 ; 6: 124-127.
98. Prabhakaran L., Lim G., Abisheganaden J., Chee CB, Choo YM Impact of an asthma education programme on patients' knowledge, inhaler technique and compliance to treatment. Singapore Med J. 2006 ; 47: 225-231.
99. Cole CH Special problems in aerosol delivery: neonatal and pediatric considerations. Respir Care. 2000 ; 45: 646-651.
100. Gillies J. Overview of delivery system issues in pediatric asthma. Pediatr Pulmonol Suppl. 1997 ; 15: 55-58.
101. Brand PL Key issues in inhalation therapy in children. Curr Med Res Opin. 2005 ; 21 (suppl 4). 27S - 32S.