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March 1981, Vol 135, No. 3 >
Article | March 1981

Techniques of Administration of Metered-Dose Aerosolized Drugs in Asthmatic Children FREE

Thomas B. Harper, MD; Robert C. Strunk, MD
[+] Author Affiliations

Reprint requests to Department of Pediatrics, National Jewish Hospital and Research Center, 3800 E Colfax Ave, Denver, CO 80206 (Dr Harper).


Am J Dis Child. 1981;135(3):218-221. doi:10.1001/archpedi.1981.02130270010005.
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• The use of medications in metered-dose aerosol form in children with asthma has increased dramatically with the development of safer, inhaled β2-adrenergic agents and the inhaled corticosteroid, beclomethasone dipropionate. However, the most appropriate techniques of administration of these agents are presently unclear, and frequent inefficient use of these metered-dose inhalers results. We review the aerosol physiology literature to determine and recommend a most efficient inhalation technique for the use of these metered-dose aerosol devices.

(Am J Dis Child 1981;135:218-221)

REFERENCES

1 +
Graeser JB, Rowe AH:  Inhalation of epinephrine for the relief of asthmatic symptoms . J Allergy 1935;;6:415-420.
2 +
Newhouse MT, Ruffin RE:  Deposition and fate of aerosolized drugs . Chest 1978;; 73( (suppl) ):936-943.
3 +
Kallos P, Kallos-Deffner L:  Medihaler: A new device for use in symptomatic treatment of bronchial asthma . Int Arch Allergy 1959;;15:343-349.
4 +
Baral E, Patterson R:  Long-term effects of beclomethasone dipropionate on prednisone dosage in the corticosteroid-dependent asthmatic . J Allergy Clin Immunol 1978;;62:72-75.
5 +
Imbeau S, Geller M:  Aerosol beclomethasone treatment of chronic severe asthma . JAMA 1978;;240:1260-1262.
6 +
Anderson SD, Seale JP, Rozen P, et al:  Inhaled and oral salbutamol in exercise-induced asthma . Am Rev Respir Dis 1976;;114:493-500.
7 +
Sly RM:  Effect of β-adrenoreceptor stimulants on exercise-induced asthma . Pediatrics 1975;;56( (suppl) ):910-915.
8 +
Schachter EN, Kreisman H, Littner M, et al:  Airway responses to exercise in mild asthmatics . J Allergy Clin Immunol 1978;;61:390-398.
9 +
Frank R:  Are aerosol sprays hazardous? Am Rev Respir Dis 1975;;112:485-489.
10 +
Bierman CW, Pierson WE:  Hand nebulizers and asthma therapy in children and adolescents . Pediatrics 1974;;54:668-670.
11 +
Woolcock AJ:  Inhaled drugs in the prevention of asthma . Am Rev Respir Dis 1977;;115:191-194.
12 +
Van Metre TE:  Adverse effects of inhalation of excessive amounts of nebulized isoproterenol on status asthmaticus . J Allergy 1969;;43:101-113.
13 +
Reisman RE:  Asthma induced by adrenergic aerosols . J Allergy 1970;;46:162-177.
14 +
Silverglade A:  Cardiac toxicity of aerosol propellants . JAMA 1972;;222:827-829.
15 +
Belej MH, Aviado DM:  Cardiopulmonary toxicity of propellants for aerosols . J Clin Pharmacol 1975;;15:105-108.
16 +
Mintzer H:  Aerosols , in Hoover JE (ed): Dispensing of Medicine. Easton , Pa, Mack Publishing Co, 1976;, pp 296-317.
17 +
Brain JD, Valberg PA:  Deposition of aerosol in the respiratory tract . Am Rev Respir Dis 1979;;120:1325-1373.
18 +
Stuart BO:  Disposition of inhaled aerosols . Arch Intern Med 1973;;131:60-72.
19 +
Brown JH, Cook KM, Ney FG, et al:  Influence of particle size on retention of particulate matter in human lungs . Am J Public Health 1950;;40:450-458.
20 +
Hiller C, Mazumder M, Wilson D, et al:  Aerodynamic size distribution of metered-dose bronchodilator aerosols . Am Rev Respir Dis 1978;;118:311-317.
21 +
Choo-Kang YFT, Parker SS, Grant IWB:  Response of asthmatics to isoprenaline and salbutamol aerosols administered by intermittent positive-pressure ventilation . Br Med J 1970;;4:465-468.
22 +
Davies DS:  Pharmacokinetics of inhaled substances . Postgrad Med J 1975;;51( (suppl 7) ):69-75.
23 +
Orehek J, Gayrard P, Grimaud C, et al:  Patient error in use of bronchodilator metered aerosols . Br Med J 1976;;1:76.
24 +
Paterson IC, Crompton GK:  Use of pressurized aerosols by asthmatic patients . Br Med J 1976;;1:76-77.
25 +
Coady T, Davies H, Barnes P:  Evaluation of a breath-actuated pressurized aerosol . Clin Allergy 1976;;6:1-6.
26 +
Connolly C:  Method of using pressurized aerosols . Br Med J 1975;;3:21.
27 +
Moren F:  Drug deposition of pressurized inhalation aerosols: I. Influence of actuator tube design . Int J Pharm 1978;;1:205-212.
28 +
Reed CE, Bhansali PV, Irvin C, et al:  Site of deposition of aerosols delivered by two methods using the dosimeter . J Allergy Clin Immunol 1979;;63:164.
29 +
Riley DJ, Weitz BW, Edelman NH:  The responses of asthmatic subjects to isoproterenol inhaled at different lung volumes . Am Rev Respir Dis 1976;;114:509-515.
30 +
Newman SP, Pavia D, Bateman JRM, et al:  Bronchodilator response after administration of pressurized aerosols of different lung volumes in patients with airway obstruction . Clin Sci 1979;;56:10-11.
31 +
Miller WF, Cherniack RM, Shapiro BA, et al:  Breathing easy . Respir Care 1978;;23:492-511.
32 +
Muir DCF, Davies CN:  The deposition of 0.5μ diameter aerosols in the lungs of man . Ann Occup Hyg 1967;;10:161-174.
33 +
Goldberg IS, Lourenco RV:  Deposition of aerosols in pulmonary disease . Arch Intern Med 1973;;131:88-91.
34 +
Pavia D, Thomson ML, Clarke SW, et al:  Effect of lung function and mode of inhalation on penetration of aerosol into the human lung . Thorax 1977;;32:194-199.
35 +
Dolovich M, Obminski G, Cockcroft DW, et al:  Standardization of inhalation tests: Influence of method of aerosol generation and inhalation . J Allergy Clin Immunol 1979;;63:165.
36 +
Muir DCF, Sweetland K, Love RG:  Inhaled aerosol boluses in man , in Walton WH (ed): Inhaled Particles III . Surrey, England, Unwin Brothers Ltd, 1970;, pp 81-89.
37 +
Palmes ED, Wang C, Goldring RM, et al:  Effect of depth of inhalation on aerosol persistence during breath holding . J Appl Physiol 1973;;34:356-360.

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References

1 +
Graeser JB, Rowe AH:  Inhalation of epinephrine for the relief of asthmatic symptoms . J Allergy 1935;;6:415-420.
2 +
Newhouse MT, Ruffin RE:  Deposition and fate of aerosolized drugs . Chest 1978;; 73( (suppl) ):936-943.
3 +
Kallos P, Kallos-Deffner L:  Medihaler: A new device for use in symptomatic treatment of bronchial asthma . Int Arch Allergy 1959;;15:343-349.
4 +
Baral E, Patterson R:  Long-term effects of beclomethasone dipropionate on prednisone dosage in the corticosteroid-dependent asthmatic . J Allergy Clin Immunol 1978;;62:72-75.
5 +
Imbeau S, Geller M:  Aerosol beclomethasone treatment of chronic severe asthma . JAMA 1978;;240:1260-1262.
6 +
Anderson SD, Seale JP, Rozen P, et al:  Inhaled and oral salbutamol in exercise-induced asthma . Am Rev Respir Dis 1976;;114:493-500.
7 +
Sly RM:  Effect of β-adrenoreceptor stimulants on exercise-induced asthma . Pediatrics 1975;;56( (suppl) ):910-915.
8 +
Schachter EN, Kreisman H, Littner M, et al:  Airway responses to exercise in mild asthmatics . J Allergy Clin Immunol 1978;;61:390-398.
9 +
Frank R:  Are aerosol sprays hazardous? Am Rev Respir Dis 1975;;112:485-489.
10 +
Bierman CW, Pierson WE:  Hand nebulizers and asthma therapy in children and adolescents . Pediatrics 1974;;54:668-670.
11 +
Woolcock AJ:  Inhaled drugs in the prevention of asthma . Am Rev Respir Dis 1977;;115:191-194.
12 +
Van Metre TE:  Adverse effects of inhalation of excessive amounts of nebulized isoproterenol on status asthmaticus . J Allergy 1969;;43:101-113.
13 +
Reisman RE:  Asthma induced by adrenergic aerosols . J Allergy 1970;;46:162-177.
14 +
Silverglade A:  Cardiac toxicity of aerosol propellants . JAMA 1972;;222:827-829.
15 +
Belej MH, Aviado DM:  Cardiopulmonary toxicity of propellants for aerosols . J Clin Pharmacol 1975;;15:105-108.
16 +
Mintzer H:  Aerosols , in Hoover JE (ed): Dispensing of Medicine. Easton , Pa, Mack Publishing Co, 1976;, pp 296-317.
17 +
Brain JD, Valberg PA:  Deposition of aerosol in the respiratory tract . Am Rev Respir Dis 1979;;120:1325-1373.
18 +
Stuart BO:  Disposition of inhaled aerosols . Arch Intern Med 1973;;131:60-72.
19 +
Brown JH, Cook KM, Ney FG, et al:  Influence of particle size on retention of particulate matter in human lungs . Am J Public Health 1950;;40:450-458.
20 +
Hiller C, Mazumder M, Wilson D, et al:  Aerodynamic size distribution of metered-dose bronchodilator aerosols . Am Rev Respir Dis 1978;;118:311-317.
21 +
Choo-Kang YFT, Parker SS, Grant IWB:  Response of asthmatics to isoprenaline and salbutamol aerosols administered by intermittent positive-pressure ventilation . Br Med J 1970;;4:465-468.
22 +
Davies DS:  Pharmacokinetics of inhaled substances . Postgrad Med J 1975;;51( (suppl 7) ):69-75.
23 +
Orehek J, Gayrard P, Grimaud C, et al:  Patient error in use of bronchodilator metered aerosols . Br Med J 1976;;1:76.
24 +
Paterson IC, Crompton GK:  Use of pressurized aerosols by asthmatic patients . Br Med J 1976;;1:76-77.
25 +
Coady T, Davies H, Barnes P:  Evaluation of a breath-actuated pressurized aerosol . Clin Allergy 1976;;6:1-6.
26 +
Connolly C:  Method of using pressurized aerosols . Br Med J 1975;;3:21.
27 +
Moren F:  Drug deposition of pressurized inhalation aerosols: I. Influence of actuator tube design . Int J Pharm 1978;;1:205-212.
28 +
Reed CE, Bhansali PV, Irvin C, et al:  Site of deposition of aerosols delivered by two methods using the dosimeter . J Allergy Clin Immunol 1979;;63:164.
29 +
Riley DJ, Weitz BW, Edelman NH:  The responses of asthmatic subjects to isoproterenol inhaled at different lung volumes . Am Rev Respir Dis 1976;;114:509-515.
30 +
Newman SP, Pavia D, Bateman JRM, et al:  Bronchodilator response after administration of pressurized aerosols of different lung volumes in patients with airway obstruction . Clin Sci 1979;;56:10-11.
31 +
Miller WF, Cherniack RM, Shapiro BA, et al:  Breathing easy . Respir Care 1978;;23:492-511.
32 +
Muir DCF, Davies CN:  The deposition of 0.5μ diameter aerosols in the lungs of man . Ann Occup Hyg 1967;;10:161-174.
33 +
Goldberg IS, Lourenco RV:  Deposition of aerosols in pulmonary disease . Arch Intern Med 1973;;131:88-91.
34 +
Pavia D, Thomson ML, Clarke SW, et al:  Effect of lung function and mode of inhalation on penetration of aerosol into the human lung . Thorax 1977;;32:194-199.
35 +
Dolovich M, Obminski G, Cockcroft DW, et al:  Standardization of inhalation tests: Influence of method of aerosol generation and inhalation . J Allergy Clin Immunol 1979;;63:165.
36 +
Muir DCF, Sweetland K, Love RG:  Inhaled aerosol boluses in man , in Walton WH (ed): Inhaled Particles III . Surrey, England, Unwin Brothers Ltd, 1970;, pp 81-89.
37 +
Palmes ED, Wang C, Goldring RM, et al:  Effect of depth of inhalation on aerosol persistence during breath holding . J Appl Physiol 1973;;34:356-360.

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