SELECTED ARTICLES FROM THE RECENT LITERATURE 2005

12/15/05

The role of the MDI and DPI in pediatric patients

Summary
Background - The use of metered dose inhalers (MDI) and dry powder inhaler (DPI) to deliver inhaled medications in asthma treatment was initially investigated mainly in adults. However, such treatment is now used extensively in asthmatic children. Is this a reliable approach in young children?

Findings - This subject was reviewed by Ahrens of the Univ of Iowa. He pointed out that through childhood there are on-going changes in: 1) patients' ability to successfully use aerosol devices; 2) pharmacokinetic/pharmacodynamic effects of the medications; 3)

The differences between children and adults are seen mainly in children younger than 4-5 years old who are unable to use DPI or plain MDI and therefore must be treated with MDI with valved holding chambers or with power nebulizers. However, there are insufficient data to say whether various MDI/holding chamber combinations are truly effective and safe, including potential for corticosteroids effects on growth velocity.

Reference
Resp Care 2005;50:1323-8

Editor's Comments
These comments by an experienced investigator of aerosol therapy are sobering in pointing out that the evidence to support aerosol therapy in young children with asthma is not as established as one would like. His contention that, in such therapy "children are not just miniature adults" should be kept in mind when treating young children with asthma.

 

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