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Current options in aerosolised drug therapy for children receiving respiratory support.

Authors
  • Trend, S1, 2
  • von Ungern-Sternberg, B S3, 4
  • Devadason, S G1
  • Schultz, A1, 2, 5
  • Everard, M L1, 5
  • 1 School of Paediatrics and Child Health, University of Western Australia, Perth, Australia. , (Australia)
  • 2 Telethon Kids Institute, University of Western Australia, Perth, Australia. , (Australia)
  • 3 School of Medicine and Pharmacology, Perth, Australia. , (Australia)
  • 4 Department of Anaesthesia and Pain Management, Perth, Australia. , (Australia)
  • 5 Department of Respiratory Medicine, Princess Margaret Hospital for Children, Perth, Australia. , (Australia)
Type
Published Article
Journal
Anaesthesia
Publisher
Wiley (Blackwell Publishing)
Publication Date
Nov 01, 2017
Volume
72
Issue
11
Pages
1388–1397
Identifiers
DOI: 10.1111/anae.14011
PMID: 28872662
Source
Medline
Keywords
License
Unknown

Abstract

Inhalation of aerosolised medications are the mainstay of treatment for a number of chronic lung diseases and have several advantages over systemically-administered medications. These include more rapid onset of action for drugs such as β-adrenergic agonists when compared with oral medication, high luminal doses for inhaled antibiotics when used to treat endobronchial infection, and an improved therapeutic index compared with systemic delivery for these and other classes of drugs such as corticosteroids. The use of aerosolised drugs to treat patients whose tracheas are intubated is less well established, in part because systemic delivery via the intravenous route can be a simpler alternative for many drugs. Consequently, research in this area is largely limited to a number of in vitro studies and very few clinical trials. Unfortunately, a lack of focus in this area has resulted in a number of practices which at best are ineffective, and at worst dangerous for the patient. Although there have been some attempts to re-invigorate research in order to improve delivery systems, current devices are, to a great extent, based on long-standing technology developed more than 50 years ago. In this review, we explore current knowledge and provide guidance as to when and how the inhaled route may be of value when treating patients whose tracheas are intubated, and we set out the challenges facing those attempting to advance the topic. We conclude by reviewing current areas of interest that may lead to more effective and widespread use of aerosols in the treatment of intubated patients.

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