Department of Pediatrics, Division of Respiratory Medicine and Allergy, Erasmus MC - Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
J Asthma. 2022 Nov;59(11):2223-2233. doi: 10.1080/02770903.2021.1996597. Epub 2021 Nov 9.
Conventional inhaler devices have a low efficacy in targeting small airways. Smart nebulizers can be used to increase deposition to small airways by adjusting the flow and depth of each inhalation based on patients 'individual inspiratory capacity. We investigated whether targeting of high dose inhaled corticosteroids (ICS) to small airways with a smart nebulizer could reduce exacerbation rate in children with severe asthma (SA).
We conducted a retrospective study in children with SA using a smart nebulizer (Akita® Jet nebulizer) for the administration of high dose ICS in our outpatient clinic at the Erasmus MC - Sophia Children's Hospital. Clinical data before and after start of treatment were collected. The primary outcome was exacerbation rate, defined as: number of asthma exacerbations for which oral corticosteroid courses (OCS) were prescribed. The exacerbation rate 1 year before treatment was compared with the exacerbation rate 1 year after start of treatment. Secondary outcomes were changes in spirometry parameters, hospital admissions and medication use.
Data on OCS use was available for 28/31 patients. Median number of asthma exacerbations requiring OCS courses 1 year before decreased from 2 (interquartile range(IQR) 2) to 0.5 (IQR 3) 1 year after treatment ( = 0.021). Hospital admission decreased from 1 (IQR 3) to 0 (IQR 1)( = 0.028). FEV1, FEF and FEF were not significantly improved after one year of treatment with the smart nebulizer ( = 0.191; = 0.248; = 0.572).
Targeting small airways with high dose ICS using a smart nebulizer resulted in a significant reduction in exacerbations requiring OCS after one year of treatment.
传统的吸入器装置在靶向小气道方面效果较低。智能雾化器可以通过根据患者的个体吸气能力调整每次吸入的流量和深度，来增加小气道的药物沉积。我们研究了使用智能雾化器将高剂量吸入性皮质类固醇（ICS）靶向小气道是否可以降低重症哮喘（SA）患儿的加重率。
我们对在 Erasmus MC - Sophia 儿童医院的门诊使用智能雾化器（Akita®Jet 雾化器）给予高剂量 ICS 的 SA 患儿进行了回顾性研究。收集治疗前后的临床数据。主要结局是加重率，定义为：需要口服皮质类固醇（OCS）治疗的哮喘加重次数。将治疗前 1 年的加重率与治疗开始后 1 年的加重率进行比较。次要结局是肺功能参数、住院和药物使用的变化。
28/31 例患者的 OCS 使用数据可用。治疗前 1 年需要 OCS 治疗的哮喘加重中位数从 2 次（四分位距[IQR] 2）减少到治疗后 1 年的 0.5 次（IQR 3）（ = 0.021）。住院人数从 1 次（IQR 3）减少到 0 次（IQR 1）（ = 0.028）。治疗 1 年后，FEV1、FEF 和 FEF 并没有明显改善（ = 0.191； = 0.248； = 0.572）。
使用智能雾化器将高剂量 ICS 靶向小气道治疗 1 年后，需要 OCS 治疗的哮喘加重显著减少。
