Resp Care
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Nebulizers have been used clinically for many years. Despite the increasing use of metered-dose inhalers and dry powder inhalers, it is likely that nebulizers will continue to be used in selected patients. A number of factors affect nebulizer performance, and these should be appreciated by clinicians who use these devices. Several new designs have recently become available that improve the performance of the nebulizer, but their cost-effectiveness remains to be determined.
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Identification of the determinants of efficient aerosol delivery and the specific challenges of aerosol delivery to infants and children can facilitate a systematic approach to optimize aerosol delivery to this population. There are inherent anatomical, physiologic, pathophysiologic, and technical limitations of aerosol efficiency in infants and young children. Nevertheless, one can enhance aerosol efficiency through application of sound principles of aerosol delivery and by exerting control over factors that are amenable to intervention. ⋯ Safety profile, therapeutic efficacy, and efficiency of aerosolized medications delivered to infants and children need to be rigorously studied. This is particularly true for medications with potentially great benefit but possible adverse effects, such as inhaled glucocorticoid therapy in extremely premature infants. Common sense, ethics, and due respect for the same high standard of approval requirements of adults and older children should motivate further research in understanding and improving aerosol delivery in infants and young children.