Dicembre 2007 - Volume XXVI - numero 10
Focus
Key words: Pneumatic nebulizer, Ultrasonic nebulizer, Metered-dose inhaler (MDI), Dry powder inhaler
The percentage of a prescribed drug that is able to reach the lung (delivery power) is low and varies widely when both nebulizers, pneumatic and ultrasonic, are used. The Metered- Doser Inhaler (MDI) has a higher and more constant efficiency, moreover when associated to a spacer provided with valves, it zeroes the ballistic effect (the impact of the drug with the oropharynx) and makes the procedure suitable for all ages. Conversely, Dry Powder Inhaler enhances the ballistic effect and requires a much higher patient collaboration. Independently from the technique used, the percentage of drug that actually reaches the lung in the child is much lower than that in adult (2-6% versus 16-20%): hence the necessity to reconsider the dosages via inhalation for paediatric use. In order to get the best collaboration on behalf of the parents it is mandatory that they are instructed on the basics of inhalation therapy and shown the correct procedure.
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Focus
Professore Ordinario f.r. di Pediatria, Università di Parma
Indirizzo per corrispondenza: aubattistini@tiscali.it
Key words: Augusta Battistini
The percentage of a prescribed drug that is able to reach the lung (delivery power) is low and varies widely when both nebulizers, pneumatic and ultrasonic, are used. The Metered- Doser Inhaler (MDI) has a higher and more constant efficiency, moreover when associated to a spacer provided with valves, it zeroes the ballistic effect (the impact of the drug with the oropharynx) and makes the procedure suitable for all ages. Conversely, Dry Powder Inhaler enhances the ballistic effect and requires a much higher patient collaboration. Independently from the technique used, the percentage of drug that actually reaches the lung in the child is much lower than that in adult (2-6% versus 16-20%): hence the necessity to reconsider the dosages via inhalation for paediatric use. In order to get the best collaboration on behalf of the parents it is mandatory that they are instructed on the basics of inhalation therapy and shown the correct procedure.
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Focus
UO di Pediatria, Ospedale San Giacomo, Castelfranco Veneto (TV)
Indirizzo per corrispondenza: dradzik@alice.it
Key words: Spacer, Asthma, Best Evidence Practice
There is clear evidence to support the use of a pressurized metered dose inhaler (pMDI)/ spacer combination in the treatment of mild to moderate acute asthma rather than a nebulizer. With the first method there are additional benefits like fewer side effects and less time spent in the Emergency Department; furthermore spacers are cheaper and more portable. Nevertheless physicians, nurses, patients and their relatives seldom use this technique: reasons for this “nebulizer culture” are briefly analyzed and useful tips of best clinical practice on this topic are presented.
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