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Bronchodilator dosage in children

The impaction of inhaled particles in the airways of children is appreciably larger than in adults [ref. 1 ], even if spacers are used. Therefore a proportionally smaller dose reaches the intrathoracic airways. On that account relatively higher dosages of beta2-agonists are administered to children than to adults to assess bronchodilator responsiveness. The dosage administered by Dutch pediatric chest physicians [ref. 2] in assessing a maximum bronchodilator effect is:

Spirometry is performed before, and 20 min. after administration of the aerosol.

Ref. 1 - Greater particle impaction in children
1 Tal A, Golan H, Grauer N, Aviram M, Albin D, Quastel MR. Deposition pattern of radiolabeled salbutamol inhaled metered-dose inhaler by means of a spacer with mask in children with airway obstruction. J Pediatr 1996; 128: 479-484.
2 Devadason SG, Everard ML, MacEarlan C, Roller C, Summers QA, Swift P, Borgström L, Le Souëf PN. Lung deposition from the Turbuhaler in children with cystic fibrosis. Eur Respir J 1997; 10: 2023-2028.
3 Backer V, Mortensen J. Distribution of radioactive aerosol in the airways of children and adolescents with bronchial hyper-responsiveness. Clin Physiol 1992; 12: 575-585.
4 Chua HL, Collis GG, Newbury AM, Chan K, Bower GD, Sly PD, LeSouef PN. The influence of age on aerosol deposition in children with cystic fibrosis. Eur Respir J 1994; 7: 2185-2191.
Ref. 2 - Dosage of dose aerosol in children
1 Merkus PJ, Eelkman Rooda HM, van Essen-Zandvliet EE, Duiverman EJ, Quanjer PhH, Kerrebijn KF. Assessment of bronchodilatation after spontaneous recovery from a histamine challenge in asthmatic children. Thorax 1992; 47: 355-359.
2 Nelson HS, Spector SL, Whitsett TL, George RB, Dwek JH. The bronchodilator response to inhalation of increasing doses of aerosolized albuterol. J Allergy Clin Immunol 1983; 72: 371-375.
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