Inhaled drugs for the prevention and treatment of bronchopulmonary dysplasia

Abstract

Bronchopulmonary dysplasia (BPD) is one of the most common long-term complications and treatment challenges in preterm infants. Theoretically, inhaled corticosteroids may suppress pulmonary inflammation without causing systemic side-effects, while bronchodilators will improve airway resistance and thereby work of breathing. This article reviews current data on these drugs in BPD prevention or treatment. Trials published to date have not demonstrated that regular bronchodilator administration influences the incidence of BPD or improves long-term outcome. Inhaled steroids started before 2 weeks of age may improve rates of successful extubation and reduce the need for rescue systemic glucocorticoids, but have not been shown to reduce the incidence of BPD. Thus, their use cannot be generally recommended. The data currently available are not sufficient to give any clearer recommendation on the use of these drugs in infants at high risk of, or established, BPD.

In Vitro Evaluation of Radio-Labeled Aerosol Delivery Via a Variable-Flow Infant CPAP System

“…Inhaled steroids, for instance, may improve the rate of successful extubation in premature infants, but do not seem to affect the rate of bronchopulmonary dysplasia. 5 Inhaled bronchodilators improve airway resistance but do not reduce the incidence of bronchopulmonary dysplasia. 5,14 These disappointing clinical results may reflect either an intrinsic lack of efficacy of these medications or suboptimal delivery.…”

“…5 Inhaled bronchodilators improve airway resistance but do not reduce the incidence of bronchopulmonary dysplasia. 5,14 These disappointing clinical results may reflect either an intrinsic lack of efficacy of these medications or suboptimal delivery. Thus, we suggest that in future neonatal aerosol studies, particularly studies on nasal CPAP, documentation of drug delivery should be included in the study design.…”

“…[1][2][3] Numerous interventions have been proposed to treat bronchopulmonary dysplasia, including the routine use of nasal CPAP and inhaled steroids; however, data regarding their efficacy are limited. 4,5 Many patients with bronchopulmonary dysplasia receive aerosolized ␤ agonist therapy, although there is little data on which to base dosing, medication deposition, SEE THE RELATED EDITORIAL ON PAGE 443 or clinical response. 5,6 It is not clear if the limited evidence of effectiveness of these interventions is due to intrinsic Ms Farney, Mr Kuehne, and Ms Gibson are affiliated with Respiratory Therapy, Neonatal Service Line; Dr Nelin is affiliated with the Center for Perinatal Research; and Dr Shepherd is affiliated with the Department of Neonatology, Nationwide Children's Hospital, Columbus, Ohio.…”

Managing Children with Bronchopulmonary Dysplasia

“…Альтернативой примене-ния системных стероидов при БЛД являются ингаляцион-ные глюкокортикостероиды (ИГКС). До настоящего вре-мени нет данных о том, что использование ИГКС у детей с формирующейся или сформированной БЛД снижает частоту развития заболевания, приводит к снижению частоты симптомов или улучшает исходы [45][46][47][48]. С одной стороны, получены доказательства, что длительное использование будесонида в виде суспензии (код АТХ: R03BA02) в качестве противовоспалительной контроли-рующей (базисной) терапии детям с БЛД приводит к лик-видации тахипноэ и одышки в покое, уменьшению частоты обострений БЛД и госпитализаций в связи с ними, умень-шает выраженность симптомов дыхательной недостаточ-ности, модифицирует течение заболевания в сторону снижения степени тяжести [49], а также снижает уровень ферментов протеолиза, активных в первом полугодии жизни у детей с БЛД [50].…”

Intrapulmonary drug administration in neonatal and paediatric critical care: a comprehensive review

“…Therefore, the potential benefits arising from their use should be weighted against the risks in each case [6]. b 2 -agonists were studied in the early 1980s for the prevention or early treatment of BPD in pre-term infants [7,8]. However, a Cochrane review demonstrated no significant effect on any major outcomes [9].…”