Pediatric Department, Ziv Medical Center, Safed, Faculty of Medicine, Technion, Haifa, Israel.
J Allergy Clin Immunol. 2010 Jun;125(6):1206-11. doi: 10.1016/j.jaci.2010.01.034. Epub 2010 Mar 24.
Infants (0-1 years of age) and young children (1-3 years of age) are a unique subpopulation with regard to inhaled therapies. There are various anatomic, physiological, and emotional factors peculiar to this age group that present significant difficulties and challenges for aerosol delivery. Most studies of therapeutic aerosols that have been performed with patients of this age group, particularly recent studies with inhaled corticosteroids (ICSs), administered aerosols with relatively large particles (ie, >3 microm in mass median aerodynamic diameter). These drugs were designed for use in adults and older children and were administered with masks, which are frequently rejected by patients. Based on these studies, it was recently suggested that ICSs might not be as therapeutically effective in infants and young children as in adults. We review the reasons that large-particle corticosteroid aerosols are not likely to be effective in infants and young children. This patient population differs from adults in airway anatomy and physiology, as well as in behavior and adherence to therapy. We suggest that the benefit of ICSs in this age group requires further evaluation to determine whether better therapeutic outcomes might be achieved with smaller particles.
对于吸入疗法来说，婴儿（0-1 岁）和幼儿（1-3 岁）是一个独特的群体。这个年龄段有许多解剖学、生理学和情感方面的特殊因素，给气溶胶输送带来了重大的困难和挑战。大多数针对该年龄段患者进行的治疗性气溶胶研究，特别是最近使用吸入性皮质类固醇（ICS）进行的研究，使用的气溶胶颗粒相对较大（即，质量中值空气动力学直径大于 3 微米）。这些药物是为成人和大龄儿童设计的，并使用面罩给药，但患者经常拒绝使用。基于这些研究，最近有人提出 ICS 在婴儿和幼儿中的治疗效果不如在成人中那么好。我们回顾了大颗粒皮质类固醇气溶胶在婴儿和幼儿中可能无效的原因。这个患者群体在气道解剖和生理学以及行为和治疗依从性方面与成人不同。我们认为，ICS 在该年龄段的疗效需要进一步评估，以确定使用较小颗粒是否可以获得更好的治疗效果。
