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Respiratory, endocrine, cardiac, and renal topics
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
Inhaled drugs are preferred because of their high therapeutic-toxic ratio, i.e. high concentrations of drug are delivered directly to the airways, with potent therapeutic effects and few systemic side effects. Several systems for inhalation exist: metered dose inhaler, dry powder inhaler or nebuliser. The use of a spacer, which facilitates the use of a metered dose inhaler, increases the deposition and decreases the side effects. For these reasons, a spacer is the treatment of choice in children below the age of 4 years. In infants and young children a spacer with a mask is indicated. Several factors will guide the choice of a spacer. Spacer and metered dose inhaler should fit properly, but also the mask or mouth piece should fit to the child. The volume of the spacer should be adapted to the lung volume of the patient and the child should be capable of moving the valves of the spacer. For children aged from 4 to 6 years, dry powder inhalers can be used, depending on the cooperation and inspiratory effort of the child. During attacks, since inspiratory effort is decreased, bronchodilators can be administered using metered dose inhaler and spacer, or using a nebuliser.
Building the patient profile
Published in Stephanie Martin, Working with Voice Disorders, 2020
Inhalers are now commonly prescribed for a variety of breathing difficulties and it is important that the clinician knows the length of time and frequency of usage of these. This is particularly so in the use of inhaled corticosteroids of which there are three main devices for inhalation therapy: pressurised metered-dose inhalers (MDIs), dry powder inhalers (DPIs) and soft-mist inhalers (SMIs) and it is important to know what type of inhaler the patient uses. Although inhaled steroids have few side effects, especially at lower doses, thrush (a yeast infection in the mouth) and hoarseness may occur, although this is rare. While it may be necessary for the patient to continue with this treatment, the impact of the medication is important to the prognosis and to the patient’s understanding of contributing and perpetuating factors. A review of the patient’s technique when using their inhaler is very important; for example, do they use a spacer as routine? Devices with metered-dose inhalers can help prevent side effects. Questions related to the patient’s post-spray regime are similarly important, such as do they rinse their mouth and gargle after using their asthma inhaler? Encouraging patients to ‘Rinse, gargle, swish and spit’ is a good mantra. It should, however, be noted that the new-generation inhalers, where strictly measured amounts of corticosteroids are ‘pre-delivered’, have far reduced the previous likelihood of excessive amounts of corticosteroids reaching the vocal folds.
Paediatric Emergencies
Published in Anthony FT Brown, Michael D Cadogan, Emergency Medicine, 2020
Anthony FT Brown, Michael D Cadogan
Give a bronchodilator such as salbutamol: Use a metered-dose inhaler with spacer device (MDI spacer). Administer 6 puffs if the child is 6 years, as a ‘single dose’.Review the response after 10 min in a mild case.Administer a burst of three doses i.e. 20 min each over one hour in moderate to severe attacks and review.The severity of the attack will determine the frequency of administration thereafter.
Nebulizer versus metered dose inhaler with space chamber (MDI spacer) for acute asthma and chronic obstructive pulmonary disease exacerbation: attitudes of patients and healthcare providers in the COVID-19 era
Published in Journal of Asthma, 2023
Rayan Alsuwaigh, Yan Cao, Youxin Puan, Anthony Yii, Soyah Binti Mohamed Noor, Hui Ye, Haijuan Chen, Xiao Ling Li, Norlidah Binte Mohd Noor, Jason Liew, Tunn Ren Tay
Inhaled short-acting bronchodilators (SAB) for the treatment of acute asthma and chronic obstructive pulmonary disease (COPD) exacerbations are widely administered via nebulizer at the emergency department (ED) and inpatient setting. The alternative administration route of metered dose inhaler (MDI) with space chamber (MDI spacer) may have comparable efficacy. For example, delivery of SAB via MDI spacer is equally efficacious in preventing hospitalizations as well as improving lung function in both children and adults with asthma exacerbations (1). The use of MDI spacer in children may even be superior, with studies reporting shorter duration of stay in ED and fewer side effects (2). There is less data regarding the use of MDI spacer in COPD exacerbations, but evidence to date does not conclusively support the use of one modality over another (3).
The use of puzzles in inhaler technique training
Published in Journal of Asthma, 2022
When patients misuse inhalers, the medicine does not reach the lungs properly (1,5). In addition, incorrect inhaler techniques may result in increased use of systemic steroids and higher hospitalization rates (6). Furthermore, using incorrect inhaler techniques may pose a problem for children even after they are given proper inhaler technique training (7,8). In a previous study, only 83% of the children could demonstrate all inhaler technique steps correctly, while 7% made at least one error. Moreover, 4.2% of the children made errors in all the steps (7). Thus, some asthmatic patients do not know the optimal inhaler technique and should be trained by healthcare professionals at the time of diagnosis, as recommended in the guidelines. In addition, the inhaler technique should be reviewed at each follow-up visit (9–12). In our country, different inhaler devices such as MDIs and dry powder inhalers (Discus, Inhaler capsules, Turbuhalers, etc.) are approved for children. Further, in line with the recommendations of the guidelines, we routinely prefer spacers for all children who use metered dose inhalers.
The pharmacists’ ability to use pressurized metered-dose inhalers with a spacer device and factors affecting it
Published in Journal of Asthma, 2021
Erdem Topal, Mustafa Arga, Abdullah Hakan Özmen, Muhammet Arif Kurşun, Ömer Adil İlhan, Mustafa Alıcı
In a study conducted by Osman et al. [10] using a metered dose inhaler with a spacer, 41% of the pharmacists were “totally unfamiliar” with the device, and 42.2% did not know how to use it correctly. Only 7.2% of the pharmacists demonstrated an “adequate technique.” Based on the results of that study, the researchers concluded that many participating community pharmacists lacked the basic knowledge and practical skills that are required to demonstrate the correct inhalation techniques of the available bronchial asthma inhaler delivery systems. This will clearly have a serious negative impact on patient education and training, as well as on the global push for better asthma care. Similar to the results of that study, 18.2% of the pharmacists in our study were unfamiliar with the inhaler spacer device, and only 39.8% of the participants who stated that they knew how to use pMDIs with a spacer device could demonstrate correct usage.