Metered‐dose inhaler therapy with spacers: Are newborns capable of using this system correctly?

Abstract

Introduction: Aerosol therapy using a metered‐dose inhaler (MDI) coupled to a spacer chamber is the most widely used long‐term treatment modality for chronic lung disease of prematurity. However, its use in neonates is based on data obtained from other age groups. Proper use of maintenance treatment is essential for the long‐term stability of these patients. Objective: To ascertain whether newborns are capable of generating negative pressure during the use of a spacer with face mask for aerosol therapy. Patients and methods: Total of 117 low‐risk newborns (age 12‐48 hours), with no congenital malformations or any detectable clinical symptoms, were included. Inspiratory pressure was measured with a respiratory pressure meter, at each respiratory cycle, during a 10‐second period, for three sequential measurements. The meter was connected to the inner chamber of the spacer through a noncollapsible silicone tube. Suitably sized masks were used. Results: Only 43 participants (36.8%) generated a negative pressure capable of opening the spacer valve, as verified by the respiratory pressure meter. In 25 patients, all three measurements were within the expected range. Weight, gestational age, and mode of delivery were in no way associated with the ability to generate a detectable negative pressure. Conclusion: In neonates, the MDI therapy with a spacer chamber and face mask is susceptible to failure due to the inability of most patients in this age range to generate a negative inspiratory pressure sufficient to open the spacer valve.

From the infant to the geriatric patient—Strategies for inhalation therapy in asthma and chronic obstructive pulmonary disease

“…There is little evidence regarding the necessary skills or the optimal age for transitioning children from the mask‐plus‐VHC concept to a mouthpiece‐plus‐VHC concept 24 . Herbes et al analysed MDI therapy with a VHC and face mask in 117 low‐risk newborns and showed that only 37% were able to generate a sufficient negative pressure to open the chamber valve 25 …”

“…24 Herbes et al analysed MDI therapy with a VHC and face mask in 117 low-risk newborns and showed that only 37% were able to generate a sufficient negative pressure to open the chamber valve. 25 Iramain et al demonstrated in 103 children (aged 2-14 years) who were admitted to the emergency room with a severe acute exacerbation of asthma, that administration of salbutamol/ipratropium by MDI with VHC and face mask was more effective than a nebulizer therapy. 26 Snider et al analysed 890 patients (aged 2-17 years) with mild to moderate asthma exacerbations and demonstrated the non-inferiority of MDI albuterol therapy compared to breath-actuated albuterol nebulizer therapy.…”

Homemade valved holding chambers for children with airway hyperresponsiveness: A randomized crossover trial

“…Reginato et al 27 showed that approximately 20% of infants under 2 years of age were unable to open the one‐way valve of various VHCs during their inspiratory cycles. Herbes et al 28 found that more than half of the newborns were unable to generate an inspiratory flow capable of opening the one‐way valve of a VHC, even when using an appropriate VHC and face mask. Therefore we would suggest observing the movement of the valves first.…”

Pediatric pulmonology 2019 year in review: Asthma

“…Herbes et al studied this in neonates at 12-48 hours of life and found that most are not capable of generating the negative inspiratory force required to open the one-way valve of a holding chamber. 36 It should be noted, however, that older infants were not studied so this may not apply in those children.…”

“…While there is good evidence that MDIs with a holding chamber work well in older children, there has been debate as to whether or not infants can use them effectively. Herbes et al studied this in neonates at 12–48 hours of life and found that most are not capable of generating the negative inspiratory force required to open the one‐way valve of a holding chamber 36 . It should be noted, however, that older infants were not studied so this may not apply in those children.…”