Dosage regimens for inhaled therapy in children should be reconsidered

: In current asthma guidelines, dosage regimens for inhalation therapy in children are based on adult doses and are generally titrated per kilogram of bodyweight or per square metre of body surface area. However, these recommendations do not correspond well with current knowledge of aerosol therapy...

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Bibliographic Details
Published in:Journal of paediatrics and child health 2002-04, Vol.38 (2), p.115-116
Main Authors: Wildhaber, JH, Mönkhoff, M, Sennhauser, FH
Format: Article
Language:English
Subjects:
Anti-Asthmatic Agents - administration & dosage
Anti-Asthmatic Agents - pharmacokinetics
Anti-Asthmatic Agents - therapeutic use
Asthma
Asthma - drug therapy
Biological and medical sciences
Child
childhood asthma
Children
delivery device
Dosage
Dose-Response Relationship, Drug
Humans
inhalation therapy
Inhalers
Lung - metabolism
lung deposition
Medical sciences
Pharmacology. Drug treatments
Respiratory system
Respiratory Therapy - instrumentation
Respiratory Therapy - standards
Switzerland
Treatment
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Summary:: In current asthma guidelines, dosage regimens for inhalation therapy in children are based on adult doses and are generally titrated per kilogram of bodyweight or per square metre of body surface area. However, these recommendations do not correspond well with current knowledge of aerosol therapy in childhood. Lung deposition of the aerosolised drug is the key determinant for clinical efficacy and for systemic side effects of inhalation therapy. Lung deposition increases with age, whereas lung deposition expressed as a percentage per kilogram bodyweight is age‐independent. This finding is explained by the self‐regulating effect of age‐dependent airway anatomy on lung deposition. Therefore, it is more likely that adult doses translate into paediatric doses only by virtue of the differences in self‐limiting pulmonary deposition when using the same absolute nominal doses of the medication. Adapting the adult dose to a paediatric dose calculated on body size might be unnecessary and could lead to insufficient pulmonary deposition of medication. These findings suggest that dosage regimens for inhalation therapy for children may have to be reconsidered, and should be determined from dose‐ranging studies rather than calculated from adult doses based on body size.
ISSN:1034-4810
1440-1754
DOI:10.1046/j.1440-1754.2002.00794.x