Clinical Side Effects during Aerosol Therapy: Cutaneous and Ocular Effects

Abstract

Aerosolized medications maximize clinical benefit by targeting the airways and minimize side effects by reducing (though not eliminating) systemic exposure. Aerosolized drugs delivered with a facemask may inadvertently deposit on the face and in the eyes, raising concerns about cutaneous and ocular side effects with these drugs. Cases of anisocoria have been reported from exposure of the eyes to aerosol bronchodilators. Whether inhaled corticosteroids (ICS) can cause skin and eye problems like those seen with systemic or topical steroids is more difficult to answer. Patients who take ICS may have other corticosteroid exposures, or have other conditions that predispose them to side effects, making the analysis of the ICS risk challenging. Also, many studies were not designed to search for cutaneous or ocular effects, or may have been too short to detect these effects. Nevertheless, ICS have been associated with an increased risk of skin thinning, bruising, cataracts and possibly glaucoma in adults, but not in children. The risks increase with advanced age, higher doses, and longer duration of use. In children, the risks of cataracts and glaucoma were negligible with ICS, whether a mouthpiece or a mask interface was used. Side effects like skin rash and conjunctivitis occurred at low frequencies similar to placebo or comparator drugs. We do not know whether exposed children will have increased risks from ICS later in life. Therefore, it is wise to avoid face and eye deposition when possible, and to use the minimally effective dose.

Numerical Investigation of Aerosol Deposition at the Eyes When Using a Hood Inhaler for Infants—a 3D Simulation

“…This is probably caused by the jet from the nozzle impinging on the eyes. Although this could happen from misuse of the funnel, the amount of aerosol deposition (reported in our study as fraction of delivered dose) is comparable to that reported previously, (17,18) and its clinical significance is yet to be studied.…”

Effect of Mask Dead Space and Occlusion of Mask Holes on Delivery of Nebulized Albuterol

“…6,7 The use of a mouthpiece is preferred over a mask because it reduces ocular and facial exposure to inhaled drugs. 8,9 However, face masks are used to facilitate the administration of nebulized therapy to patients who are unable to use a mouthpiece. Masks of different designs and sizes are commercially available.…”

Drug Delivery in Asthmatic Children Following Coordinated and Uncoordinated Inhalation Maneuvers: A Randomized Crossover Trial

“…(15) Also, the use of a mouthpiece avoids any facial, and potentially ocular, exposure that occurs with a facemask. (16) Traditionally, the use of mouthpiece has been associated with the performance of a single-breath inhalation maneuver. In our study, we successfully used tidal breathing (three breaths) following the actuation of the inhaler.…”