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Key issues in inhalation therapy in children.

In order to achieve asthma control it is essential that children receive the appropriate education and training pertaining to the management of their disease, are prescribed the correct medication according to severity, and most importantly, are prescribed the correct inhaler to ensure medication is deposited in their lungs. There are three major misconceptions which physicians and patients have regarding the use of inhalers in children. Firstly, that the nebulizer is more effective than a pressurised metered dose inhaler (pMDI) plus spacer in treating acute asthma in children. Secondly that using an inhaler correctly is easy, and lastly that correct use of the inhaler, once taught, persists over time. However, recent studies have shown that these conceptions are false. Firstly, comparable efficacy is achieved by treatment with inhaled corticosteroids or bronchodilators delivered through a nebulizer and a pMDI plus spacer, both when used to treat acute asthma and for maintenance therapy. Secondly, contrary to general opinion, using an inhaler correctly is difficult for children. Many children with asthma use their inhaler devices incorrectly, even after instruction for correct use of the inhaler. Thirdly, correct inhalation technique deteriorates over time; and inhalation instructions, therefore, should be given repeatedly to achieve and maintain correct inhalation technique in asthmatic children. The profile of the ideal inhaler comprises good drug deposition in the lower airways, deliverance of a consistent dose, being easy to teach and to use correctly, and being small in size and convenient to handle. It should also be multidose, require a low inspiratory airflow for activation, provide feedback to patients on correct use of the inhaler, be re-usable, have an appealing design and feel, and have a reliable dose counter which may help to monitor the patient's compliance. The Novolizer device, a new multidose dry powder inhaler (DPI), shows many of these characteristics making it potentially very suitable for children with asthma.

Administration, Inhalation↗

[Psychosomatic study of inhalation therapy in patients with bronchial asthma. I. Evaluation by questionnaire].

We investigated the use of metered-dose beta agonist inhalers (MDIs) by means of 17-item questionnaires from the standpoint of psychosomatic medicine in 56 subjects with bronchial asthma. The results can be summarized as follows: 1) Many asthmatics with neurotic characters used MDIs frequently; Thirteen percent of them suffered adverse effects. The number of times the inhalers were used increased in proportion to the severity and the duration of illness. Fifteen percent of the subjects used MDIs frequently because of anxiety. 2) Fifty percent of the subjects, most of them had neurotic or alexithymic characters, used MDIs without suffering from dyspnea or wheezes; the subjects who used MDIs because of anxiety increased in proportion to the duration of illness. 3) Seventy eight percent of the subjects were anxious about asthmatic attack when they did not carry any MDI; sixty two percent of the subjects, most of them had neurotic or alexithymic characters, actually experienced asthmatic attack. 4) Seventy three percent of the subjects used MDIs secretly; sixty percent of the subjects did not like to inhale in the presence of others. 5) There were some subjects who acted incorrectly on or after asthmatic attack when MDIs were not effective.

Adolescent↗

Rewarming in immersion hypothermia: radio-wave and inhalation therapy.

Anesthetized random source dogs were cooled by ice water immersion (1 degree C) to a stable core temperature of 25 degrees C, and subsequently rewarmed with warm humidified inhalation (43 degrees C, 450 cc of min ventilation/kg), radio wave induction hyperthermia (4-6 W/kg) or both therapies simultaneously. The mean time required for core rewarming to 30 degrees C was 262 +/- 29 min for humidified ventilation, 68.5 +/- 6 min for radio wave therapy (P less than 0.01), and 74.8 +/- 12 for both therapies combined (P less than 0.3 vs. radio wave). There was no tissue damage with these protocols. These data suggest radio wave heating alone is the most rapid non-invasive method for core rewarming in immersion hypothermia.

Animals↗

[Efficacy of long-term beclomethasone dipropionate inhalation therapy in pediatric patients with asthma, and its effect on height growth and adrenocortical functions].

Seventy-eight pediatric patients with moderate to severe chronic asthma, aged 6 to 16 years, who failed to respond well to inhaled DSCG and theophylline RTC, were treated with beclomethasone dipropionate inhaler (BDI) for 0.5 to 10 years (mean: 4.2 +/- 2.4 years). The efficacy rate gradually increased with time: 61.1% at one year after the start of the treatment and 89.5% at three years. Long-term BDI therapy over five years did not cause suppression of height growth or adrenocortical functions (early morning cortisol level and rapid ACTH test). However, the safety of long-term BDI therapy in children still needs to be studied more thoroughly and established. Further investigation will be necessary since some cases did not respond to BDI therapy while others died of exacerbated asthmatic symptoms soon after the start of BDI therapy.

Administration, Inhalation↗

Rewarming in accidental hypothermia: radio wave versus inhalation therapy.

Anesthetized random-source dogs were cooled by refrigeration (3 C) to a stable core temperature of 25 C, and subsequently were rewarmed with warm, humidified inhalation (43 C, 450 mL of minute ventilation per kilogram) or radio frequency induction hyperthermia (4 to 6 watts/kg). The mean time required for core rewarming to 30 C was 231 +/- 3 minutes for warm, humidified ventilation and 106 +/- 32 minutes for radio wave therapy (P less than .01). These data suggest that radio wave heating is a more rapid noninvasive therapy for core rewarming of accidental hypothermia.

Animals↗

[Proposals for inhalation therapy with ultrasonic nebulizers (author's transl)].

With aerosols active substances (drugs) can be transported for treatment. Their effect depends on the choice of apparata, the drugs used, and the procedure of inhalation. The use of electronic nebulizers is effective because a sufficient volume of liquid substances can be nebulized by this way. Bronchospasmolytics, secretolytics, antiphlogistics, and antibiotics may be used. The right connexion of the patient, who should inhale in a closed system is important for an effective treatment. The patient is exposed to some hazards by contamination with inhaled bacteria, by hyperventilation, bronchospasm and by allergic reactions.

Aerosols↗