Delivery of inhaled medications to children with asthma by a small-volume nebulizer is an antiquated method. Delivery by metered dose inhaler through a valved holding chamber with mask is at least equally effective, but more convenient, safer, faster, and less expensive. In addition, antistatic chambers increase the amount of drug delivered to the airways. This is an advantage for albuterol, but could increase the risk of long-term systemic adverse effects of inhaled corticosteroids at higher doses.
Get full access to this article
View all access options for this article.
References
1.
Castro-RodriguezJA, RodrigoGJ. Beta-agonists through metered-dose inhaler with valved holding chamber versus nebulizer for acute exacerbation of wheezing or asthma in children under 5 years of age: a systematic review with meta-analysis. J Pediatr, 2004; 145:172–177.
2.
SchuhS, JohnsonDW, StephensD, CallahanS, WindersP, CannyGJ. Comparison of albuterol delivered by a metered dose inhaler with spacer versus a nebulizer in children with mild acute asthma. J Pediatr, 1999; 135:22–27.
3.
KeremE, LevisonH, SchuhS, O'BrodovichH, ReismanJ, BenturL, CannyGJ. Efficacy of albuterol administered by nebulizer versus spacer device in children with acute asthma. J Pediatr, 1993; 123:313–317.
4.
DelgadoA, ChouKJ, SilverEJ, CrainEF. Nebulizers vs metered-dose inhalers with spacers for bronchodilator therapy to treat wheezing in children aged 2 to 24 months in a pediatric emergency department. Arch Pediatr Adolesc Med, 2003; 157:76–80.
5.
LevershaAM, CampanellaSG, AickinRP, AsherMI. Costs and effectiveness of spacer versus nebulizer in young children with moderate and severe acute asthma. J Pediatr, 2000; 136:497–502.
6.
HendelesL, HattonRC, CoonsTJ, CarlsonL. Automatic replacement of albuterol nebulizer therapy by metered-dose inhaler and valved holding chamber. Am J Health-Syst Pharm, 2005; 62:1053–1061.
7.
PloinD, ChapuisFR, StammD, RobertJ, DavidL, ChatelainPG, DutauG, FloretD. High-dose albuterol by metered-dose inhaler plus a spacer device versus nebulization in preschool children with recurrent wheezing: a double-blind, randomized equivalence trial. Pediatrics, 2000; 106:311–317.
8.
MandelbergA, TsehoriS, HouriS, GiladE, MoragB, PrielIE. Is nebulized aerosol treatment necessary in the pediatric emergency department?Chest, 2000; 117:1309–1313.
9.
WexlerMR, RhameFS, BlumenthalMN, CameronSB, JuniBA, FishLA. Transmission of gram-negative bacilli to asthmatic children via home nebulizers. Ann Allergy, 1991; 66:267–271.
10.
MallolJ, AguirreV, BarruetoL, WandalsenG, TepperR. Effect of inhaled fluticasone on lung function in infants with recurrent wheezing: a randomised controlled trial. Allergol Immunopathol (Madr), 2009; 37:57–62.
11.
BisgaardH, GilliesJ, GroenewaldM, MadenC. The effect of inhaled fluticasone propionate in the treatment of young asthmatic children: a dose comparison study. Am J Respir Crit Care Med, 1999; 160:126–131.
12.
TeperAM, KofmanCD, SzulmanGA, VidaurretaSM, MaffeyAF. Fluticasone improves pulmonary function in children under 2 years old with risk factors for asthma. Am J Respir Crit Care Med, 2005; 171:587–590.
13.
TeperAM, ColomAJ, KofmanCD, MaffeyAF, VidaurretaSM, BergadáI. Effects of inhaled fluticasone propionate in children less than 2 years old with recurrent wheezing. Pediatr Pulmonol, 2004; 37:111–115.
14.
QaqundahPY, SugermanRW, CerutiE, MasperoJF, KlehaJF, ScottCA, WuW, MehtaR, CrimC. Efficacy and safety of fluticasone propionate hydrofluoroalkane inhalation aerosol in pre-school-age children with asthma: a randomized, double-blind, placebo-controlled study. J Pediatr, 2006; 149:663–670.
15.
CarlsenKC, StickS, KaminW, CiruleI, HughesS, WixonC. The efficacy and safety of fluticasone propionate in very young children with persistent asthma symptoms. Respir Med, 2005; 99:1393–1402.
KhanY, TangY, HochhausG, ShusterJJ, SpencerT, ChesrownS, HendelesL. Lung bioavailability of hydrofluoroalkane fluticasone in young children when delivered by an antistatic chamber/mask. J Pediatr, 2006; 149:793–797.
18.
BlakeK, MehtaR, SpencerT, KunkaRL, HendelesL. Bioavailability of inhaled fluticasone propionate via chambers/masks in young children. Eur Respir J, 2012; 39:97–103.
19.
BarryPW, O'CallaghanC. Inhalational drug delivery from seven different spacer devices. Thorax, 1996; 51:835–840.
20.
DoubWH, AdamsWP, WokovichAM, BlackJC, ShenM, BuhseLF. Measurement of drug in small particles from aqueous nasal sprays by Andersen cascade impactor. Pharm Res, 2012[Epub ahead of print]10.1007/s11095-012-0804-7.
21.
MitchellJP, NagelMW, WiersemaKJ, DoyleCC. Aerodynamic particle size analysis of aerosols from pressurized metered-dose inhalers: comparison of Andersen 8-stage cascade impactor, next generation pharmaceutical impactor, and model 3321 Aerodynamic Particle Sizer aerosol spectrometer. AAPS PharmSciTech, 2003; 4:E54.
22.
LiangJ, AsmusMJ, HochhausG, ChesrownS, HendelesL. Differences in inhaled fluticasone bioavailability between holding chambers in children with asthma. Pharmacotherapy, 2002; 22:947–953.
23.
DolovichMB, AhrensRC, HessDR, AndersonP, DhandR, RauJL, SmaldoneGC, GuyattG. Device selection and outcomes of aerosol therapy: evidence-based guidelines: American College of Chest Physicians/American College of Asthma, Allergy, and Immunology. Chest, 2005; 127:335–371.
24.
BisgaardH, AnhøjJ, KlugB, BergE. A non-electrostatic spacer for aerosol delivery. Arch Dis Child, 1995; 73:226–230.
25.
AnhøjJ, BisgaardH, LipworthBJ. Effect of electrostatic charge in plastic spacers on the lung delivery of HFA-salbutamol in children. Br J Clin Pharmacol, 1999; 47:333–336.
26.
AnhøjJ, ThorssonL, BisgaardH. Lung deposition of inhaled drugs increases with age. Am J Respir Crit Care Med, 2000; 162:1819–1822.
27.
LipworthBJ, LeeDK, AnhøjJ, BisgaardH. Effect of plastic spacer handling on salbutamol lung deposition in asthmatic children. Br J Clin Pharmacol, 2002; 54:544–547.
28.
ElmallahMK, KhanY, HochhausG, ShusterJJ, HendelesL. Systemic exposure to fluticasone MDI delivered through antistatic chambers (letter)J Allergy Clin Immunol, 2011; 128:1113–1115.
29.
PrabhakaranS, ShusterJ, ChesrownS, HendelesL. Response to albuterol MDI delivered through an anti-static chamber during nocturnal bronchospasm. Respir Care, 2012; 57:1291–1296.
30.
MasoliM, WeatherallM, HoltS, BeasleyR. Systematic review of the dose-response relation of inhaled fluticasone propionate. Arch Dis Child, 2004; 89:902–907.
31.
KellyHW, SternbergAL, LescherR, FuhlbriggeAL, WilliamsP, ZeigerRS, RaissyHH, Van NattaML, TonasciaJ, StrunkRC. CAMP Research Group. Effect of inhaled glucocorticoids in childhood on adult height. N Engl J Med, 2012; 367:904–912.
32.
GellerDE, KesserKC. Effects of pretreatment of static and nonstatic holding chambers (HC) on the delivery of Flovent 110-HFA (F) in an infant airway model (abstract)Am J Respir Crit Care Med, 2006; 3:A85.
