ABSTRACT

Aerosol therapy is a modality of inhaled therapy in which the drug is administered directly to its site of action, allowing the employment of lower doses and leading to a faster therapeutic response, often with less systemic effects. There are several aerosol-generating devices. Jet nebulizer functions through a flow of gases (air or oxygen) that produces negative pressureinto a capillary tube submerged in a deposit, provoking absorption of the liquid and its break in small particles when it hit against deflectors. Ultrasonic nebulizer uses a piezoelectric cristal that vibrates at high frequency and produces oscillations in the liquid, releasing microscopic drops. The major advantage of nebulizers over inhalers is that nebulization can be accomplished during a normal, quiet respiration and does not require the patient’s cooperation.The metered-dose inhaler is a metallic canister that contains a solution or suspension of one or more drugs under pressure and its aerosols are released through a valve actuation. In children, intrapulmonary deposit is lower than 10%, though it can be enhanced with the use of spacer devices. The dry-powder inhalers are activated by the patient’s inspiratory effort, and are of three types, the Diskus^®, the Turbuhaler^® and Handihaler, which achieve a pulmonary deposit between 15 and 25%.

KEYWORDS

Aerosol, drug aerosol therapy, nebulizers, inhalers.

REFERENCES

1. Escobedo-Arenas G. Aerosolterapia. En: Furuya MEY, Hernández E (editoras). Enfermedades respiratorias en niños. México: El Manual Moderno, 2002.

2. Maza-Toledo A. Empleo de fármacos por inhalación. Rev Mex Pediatría 1998; 65:182-186.

3. O’Collaghan C, Barry PW. The science of nebulized drug delivery. Thorax 1997; 52(Suppl. 2): S31-S44.

4. Coates AI, Ho S. Drug administration by jet nebulization. Pediatr Pulmonol 1998; 26: 412-423.

5. Fiel S. History and evolution of aerosolized therapeutics. Chest 2001; 120: 87S-88S.

6. Anderson P. Delivery options and devices for aerosolized therapeutics. Chest 2001; 120: 89S-93S.

7. Janssens HM, Devadason SG. Variability of aerosol delivery via spacer devices in young asthmatic children in daily life. Eur Respir J 1999; 13: 787-791.

8. Dolovich M. Rationale for spacer use in children. Pediatr Pulmonol 1997; 16: 184S-185S.

9. Rau J. Delivery of aerosolized drugs to neonatal and pediatric patients. Respir Care 1991; 36: 514-544.

10. Dhand R, Tobin MJ. Inhaled drug delivery in mechanically-ventilated patients. Eur Respir J 1998; 3: 139-157.

11. British Thoracic Society Nebulizer Project Group. Current best practice for nebulizer treatment. Thorax 1997; 52(Suppl. 2): S1-S3.

12. Dolovich M. Aerosol delivery in children. Pediatr Pulmonol 1999; 18: 79-82.

13. Rubilar L, Castro-Rodríguez JA. Randomized trial of salbutamol via metered-dose inhaler UIT spacer versus nebulizer for acute wheezing in children less than 2 years of age. Pediatr Pulmonol 2000; 29: 264-269.

14. The COPD Guidelines Group of the Standards of Care Committee of the BTS. BTS guidelines for the management of chronic obstructive pulmonary disease. Thorax 1997; 52(Suppl. 5): S1-S28.

15. Arvid WA, Kamps MD. Poor inhalation technique, even after inhalation instructions, in childrens with asthma. Pediatr Pulmonol 2000; 29: 39-42.