Aerosol delivery of nebulised budesonide in young children with asthma

Schueepp, Karen G.; Devadason, Sunalene G.; Roller, Christina; Minocchieri, Stefan; Moeller, Alexander; Hamacher, Jürg; Wildhaber, Johannes H.

doi:10.1016/j.rmed.2009.04.029

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Volume 103, Issue 11 , Pages 1738-1745, November 2009

Aerosol delivery of nebulised budesonide in young children with asthma

Karen G. Schueepp
- Swiss Paediatric Respiratory Research Group, Department of Pediatrics and Respiratory Medicine, University Children's Hospital, 3010 Berne, Switzerland
- Corresponding author. Department of Paediatrics, University Children's Hospital, 3010 Bern, Switzerland. Tel.: +41 31 632 21 11; fax: +41 31 632 94 84.
Sunalene G. Devadason
- Perth Medical Aerosol Research Group, University of Western Australia, School of Paediatrics and Child Health, Princess Margaret Children's Hospital, 6000 Perth, WA, Australia
Christina Roller
- Perth Medical Aerosol Research Group, University of Western Australia, School of Paediatrics and Child Health, Princess Margaret Children's Hospital, 6000 Perth, WA, Australia
Stefan Minocchieri
- Swiss Paediatric Respiratory Research Group, Department of Pediatrics and Respiratory Medicine, University Children's Hospital, 3010 Berne, Switzerland
Alexander Moeller
- Swiss Paediatric Respiratory Research Group, Division of Respiratory Medicine, University Children's Hospital Zürich, 8032 Zürich, Switzerland
Jürg Hamacher
- Pulmonary Medicine, Bern University Hospital, 3010 Berne, Switzerland
Johannes H. Wildhaber
- Swiss Paediatric Respiratory Research Group, Department of Paediatrics, 1700 Fribourg, Switzerland

Received 12 June 2008; accepted 30 April 2009. published online 19 June 2009.

Summary

Background

Lung deposition of inhaled steroids, likely to be of benefit in the anti-inflammatory treatment of asthma in young children, is low. This is explained by age specific anatomical and physiological characteristics as well as poor cooperation with aerosol therapy. However, total lung deposition and the ratio of lung deposition to oropharyngeal deposition are key determinants of clinical efficacy and of systemic side effects of aerosolized drugs.

Objectives

The aim of this study was to determine lung deposition and ratio of lung deposition to oropharyngeal deposition using a modified vibrating membrane nebuliser to deliver budesonide with a small particle size, taking into account the needs of young children.

Patients and methods

Ten asthmatic children (5 males), mean age 20.3 months (range 6–41 months) inhaled radiolabelled budesonide (MMD 2.6μm) through a modified vibrating membrane nebuliser (modified PARI e-Flow^®). Lung deposition expressed as a percentage of the emitted dose was measured using scintigraphy and the ratio of lung deposition to oropharyngeal deposition was calculated.

Results

Mean lung deposition (SD) expressed as percentage of emitted dose and mean lung to oropharyngeal deposition ratio (SD) in quietly breathing children (n=5) and in children crying during inhalation were 48.6% (10.5) versus 20.0% (10.9), and 1.0 (0.3) versus 0.3 (0.2), respectively.

Conclusions

We have shown that by using an improved age-adjusted complementary combination of delivery device and drug formulation to deliver small particles, lung deposition and ratio of lung deposition to oropharyngeal deposition in young asthmatic children is highly improved. But the main factor limiting aerosol delivery in this age group remains cooperation.

Keywords: Inhalation therapy, Nebuliser, Childhood asthma, Radiolabelled aerosols, Infants

Abbreviations: BPD, beclomethasone diproprionate, CFC, chlorofluorocarbon, DTPA, diethylenetriamine penta-acetic acid, HFA, hydrofluoroalkane, MBq, megabecquerels, MMAD, mass median aerodynamic diameter, P:C ratio, peripheral to central ratio, SD, standard deviation