Introduction
Asthma remains one of the world’s leading causes of chronic diseases in children, and the incidence of this condition is increasing every year (Carter, 2008). However, ethical and logistical problems, lack of an objective criterion for diagnosis as well as variability of the expression of childhood wheezy illnesses in children under the age of five years are some of the main problems that cause poor understanding of global epidemiological studies in this group of patients (Carter, 2008). One of the major causes of dilemma, however, is the inability to manage and treat the condition in children under the age of 7 years due to ethical dilemma. For instance, it is worth noting that the use of inhalers and the degree to which such methods should be used in children remains a dilemma. Although metered-dose inhalers (MDIs) as well as dry powder inhalers have been successful in managing the condition, they react differently in children than in adults. Pharmacological evidence has shown that children are unable to use DPIs or MDIs on their own without assistance from an adult.
Analysis
The research article by Ahrens (2005) has attempted to address this issue through an in-depth analysis of the ethical dilemma that has resulted from the argument on whether children should be allowed to carry these substances as a form of medication. In this study, the researcher attempts to review a wide range of information and findings from previous studies on the topic, most of which are based empirical studies.
To introduce the topic, the author has provided a brief background to aerosol drug delivery in children and a comparable use in adults. The author acknowledges the previous findings that aerosol drug delivery is an important method of treating children with various conditions, especially in managing diseases of the lungs, cystic fibrosis, bronchopulmonary dysplasia, asthma and viral bronchiolitis/croup. Using the example of dry powdered inhalers (DPIs) and Metered-dose inhalers (MDIs), Ahrens has analysed the effectiveness of aerosol drug delivery in managing such diseases/conditions in children and the dilemma that has emerged over their use as unassisted self-medication.
First, the author has explained, using previous findings, the factors that influence treatment of asthma and other conditions using aerosol as a drug delivery pathway in children. The truism “children should not be treated just as miniature adults” has been shown to be the main argument leading to the ethical dilemma. The differences between child and adult physiological and anatomical aspects have brought a strong debate over the possibility of taking children as miniature adults, yet the differences justify otherwise. These differences profoundly affect the use of certain medical interventions in treating children, especially in terms of the pharmacological aspects of the drug and its reaction with the body systems.
First, the aerosol device used to deliver the drug to the child is an issue of debate in the dilemma. Some of the methods used in both unassisted MDIs and DPIs have been found inappropriate for application in children because they may be depositing varying dosages. Secondly, the dosage given to the child is a factor that affects aerosol treatment in children because some of the DPIs and MDIs have no specific dosages, and may be used in excess even in small children. Moreover, the point of drug deposition with aerosols is debatable. For instance, the availability of the drug to the systematic circulation in the sum of oral and pulmonary components is greatly varying. The drug may be supplied as aerosols by deposition in the oropharynx or directly to the lung. When deposited in the oropharynx, the drug will arrive in the systemic circulation in lesser amounts than that deposited in the lungs. If the drug is deposited in the oropharynx, it will pass through the gut and the liver, exposing it to First Pass Elimination. This is in contrast to direct deposition in the lungs, where the drug avoids first pass elimination by going direct to the systemic circulation.
Conclusion
The author further provides an analysis of the use of MDIs and DPIs in young children as a factor contributing to the dilemma in two major ways. For instance, the use of the two devices in children is limiting and thus an issue of importance in the debate. It has been shown that proper unassisted use of MDI is a problem. The only alternative to control asthma using this method is to use MDI attached to a valve-holding chamber or an MDI actuated for breath (Carter, 2008).
The author concludes that although aerosol treatment of asthma and other conditions are some of the most effective methods, their use in children is still a problem.
References
Ahrens, R. C. (2008).The Role of the MDI and DPI in Pediatric Patients: “Children Are Not Just Miniature Adults”. Respiratory Care, 50(10), 1323-1330.
Carter, C. E. (2008). Fluticasone vs placebo in toddlers with asthma: good science or questionable ethics? Chest, 122, 2267-2268.