Nebulization of corticosteroids to asthmatic children: large variation in dose inhaled.

BACKGROUND AND OBJECTIVE: Despite problems associated with assessing the clinical effect and side effects of nebulized corticosteroids, little is known of the amount of drug that is inhaled by children with asthma or how this is affected by different drug formulations. The aim of this study was to test the hypothesis that children with asthma inhale the same proportion of the prescribed dose of nebulized fluticasone, beclomethasone dipropionate (BDP) and flunisolide. METHODS: The amount of nebulized drug that would have been inhaled by asthmatic children was captured on filters between the patient and nebulizer, and the amount contained in particles likely to reach the lung (i.e. <5 µm) is determined. RESULTS: The children studied would have inhaled 13% of the prescribed dose of fluticasone propionate, 21% of BDP and 25% of flunisolide. However, the percentage of the dose inhaled that was contained in particles <5 µm, and therefore more likely to reach the lungs, was only 5% of the prescribed dose of fluticasone propionate, 8% for BDP and 16% for flunisolide. The inter-subject variation coefficient of the dose inhaled was much greater for suspensions of fluticasone propionate (34%) and BDP (45%) than for suspensions of flunisolide solution (9%). CONCLUSIONS: Our results demonstrate that the prescribed dose may bear little resemblance to the dose delivered from a nebulizer and that the dose inhaled is significantly affected by the drug formulation prescribed.

Nebulisation of corticosteroid suspensions and solutions with a beta(2) agonist.

The aim of this study was to determine the output of salbutamol nebulised in combination with either flunisolide or beclometasone dipropionate (BDP) from two different nebulisers under simulated breathing conditions. The BimboNeb and Nebula nebulisers were used to nebulise 3.0 mL of the two drug mixtures (salbutamol, 5000 microg plus either flunisolide, 600 microg, or BDP, 800 microg). Particle size was determined by inertial impaction. Total outputs of all drugs from both nebulisers were measured using a sinus flow pump under simulated paediatric and adult breathing patterns. The mass median aerodynamic diameter (MMAD) of BDP particles from the mixture was 6.34 mum using the BimboNeb and 5.34 mum using the Nebula. Values for salbutamol in this mixture were 3.93 and 3.32 microm, respectively. The MMAD of flunisolide particles from the BimboNeb and Nebula were 3.74 and 3.65 microm, respectively, while for salbutamol were 3.79 and 3.74 microm, respectively. With the simulated adult breathing pattern, all drug outputs from both mixtures were greater from the BimboNeb than from the Nebula after 5 and 10 min' nebulisation. Drug delivery from the BimboNeb, but not the Nebula, was affected by the simulated breathing pattern. Outputs with the BimboNeb were lower with the paediatric breathing pattern than with the adult pattern. In the majority of cases, nebulising for 10 min produced significantly greater drug output than after 5 min. For the Nebula, outputs were generally similar at 5 and 10 min, irrespective of the breathing pattern. These results highlight the need to assess the amount of aerosolised drug available when drugs are combined, when different nebulisers are used and when they are used with patients of different ages.

Enhanced delivery of nebulised salbutamol during non-invasive ventilation.

Non-invasive ventilation (NIV) is used to treat acute respiratory failure. Nebulised drugs can be delivered concurrently with NIV or during breaks from ventilatory support. We hypothesised that the amount of nebulised salbutamol inhaled when delivered via bi-level ventilation would be no different to the amount available directly from the same nebuliser. A standard bi-level ventilation circuit was attached to a lung model simulating adult respiration. Drug delivery was compared when salbutamol (5 mg) was nebulised at different positions in the circuit and separately, with no ventilator. The amount of salbutamol contained in various particle size fractions was also determined. Nebuliser position within the NIV circuit was critically important for drug delivery. Optimal delivery of salbutamol occurred with the expiration port between the facemask and nebuliser (647+/-67 micro g). This was significantly better than nebulisation without the ventilator (424+/-61 micro g; P < 0.01). Delivery when the nebuliser was positioned between the facemask and expiration port was 544+/-85 micro g. The amount of salbutamol contained in particles < 5 micro m was significantly increased when the nebuliser was used in conjunction with bi-level ventilation (576+/-60 micro g vs 300+/-43 micro g, P < 0.001). We conclude that nebulised bronchodilator therapy, using a Cirrus jet nebuliser, during bi-level ventilation increases respirable particles likely to be inhaled when the nebuliser is optimally positioned within the circuit.

The 2001 Kentucky Childrens Oral Health Survey: findings for children ages 24 to 59 months and their caregivers.

PURPOSE: This study was performed to provide a 2001 benchmark of oral health status of children in Kentucky with a comparison to the most recent state (1987) and national surveys. METHODS: Using Basic Screening Survey protocols for visual screenings, a sample of 572 children ages 24 to 59 months was screened in health department clinics and physicians' and pediatric dentists' offices across Kentucky after caregivers completed a questionnaire. Screeners were provided modified Association of State and Territorial Dental Directors training materials. Analyses on the sample and population estimates were done with SAS and SUDAAN software. This weighted population estimate analysis is based on the assumption that sampled children at participating sites are representative of other children at that site, as well as children at refusing sites. RESULTS: Sample data and adjusted population estimates closely approximated each other. Population estimates indicated that 43% had untreated caries, 47% had caries experience (early childhood caries), and 31% had severe early childhood caries. Thirty-seven percent of the children needed early care, 9% needed urgent care, 39% had never been to the dentist, 44% had a history of "bad bottle behaviors," and 35% of the parents had not been to the dentist within the last year. CONCLUSIONS: Dental caries is a major health and early childhood development problem in high-risk preschool children in Kentucky.