Optimal administration of bronchodilators with valved holding chambers in preschool children: a review of literature

Abstract

Our aim was to synthesize the published literature on factors that potentially affect the delivery of bronchodilators using valved holding chambers (VHC) in preschool children. We also aimed to identify those attributes that are not yet incorporated or clearly stated in the guidelines and those topics that are still lacking sufficient data. There is strong evidence supporting several recommendations in current guidelines. Based on present knowledge, bronchodilators should be delivered by VHC administering each puff separately. Face mask should be omitted as soon as the child can hold the mouthpiece of the VHC tightly between the lips and teeth. Based on the review, we suggest adding a specific note to current guidelines about the effect of chamber volume and the impact of co-operation during drug administration. Calming the child and securing a tight face-to-mask seal is critical for successful drug delivery. There is not enough evidence to make specific recommendations on the most reliable VHC and face mask for children. There is an urgent need for studies that evaluate and compare the effectiveness of VHCs in various clinical settings in wide age-groups and respiratory patterns. In addition, there is insufficient data on ideal chamber volume, material, and effective antistatic treatment. What is Known:• Valved holding chambers (VHC) should not be considered interchangeable when used with pressurized metered dose inhalers (pMDI).• Drug delivery is influenced by VHC volume, aerodynamic and electrostatic properties; mask fit; respiratory pattern and co-operation during inhalation; and the number of puffs actuated.What is New:• The impact of co-operation, VHC volume, and good mask-to-face fit during drug inhalation is not stressed enough in the guidelines.• Studies are urgently needed to evaluate the effectiveness of different VHCs in various clinical settings focusing on VHC electrostatic properties, respiratory patters, face masks, and ideal pMDI+VHC combinations.

Optimization of Child Literature Curriculum Settings for Preschool Education Based on Numerical Analysis

“…Assuming that two adjacent targets are scheduled to be executed in the same database, the time taken to transmit is zero [17,18]. e optimal setting length T of child literature courses for preschool education majors can be defined as the maximum value of all corresponding outgoing targets:…”

“…In today's preschool education field, there is a shortage of educators who not only possess profound preschool education theories, rich practical research foundations but also theoretical foundations of child literature, that is, teachers with dual professional backgrounds in education and literature [19]. ere is also the problem of ignoring the special psychological laws of young children in terms of values and ethical tendencies.…”

Pulmonary

“…14.16), although the use of face masks is associated with many problems and challenges as reviewed by Csonka er al. [20]. Particularly a tight fit to the face is important as a small leak can already reduce the output dose to zero [21,22].…”

Something Is Changing in Viral Infant Bronchiolitis Approach

“…More specifically, we propose that an inhaled bronchodilator trial could be considered particularly in children older than 6 months of age, but two specific conditions must be advised. The first is that in these infants, that we can consider as “viral wheezers,” bronchodilators should be administrated by metered-dose inhalers and valved holding chambers, as recommended by current guidelines, since this method is more effective and with less side effects than nebulized therapy ( 50 , 51 ). The second is the indication to observe a clinical improvement with clinical scores after the bronchodilator trial ( 52 ).…”