Background and aim Inhaled corticosteroids reduce lung inflammation in chronic lung disease (CLD) and may be safer than systemic dexamethasone treatment, but evidence of better efficacy is lacking. State-of-the-art aerosol delivery systems may permit enhanced alveolar steroid delivery compared with traditional metered-dose inhalers/spacers or jet nebulisers. We evaluated a new-generation electronic micropump vibrating-mesh nebuliser for topical airways delivery of budesonide in infants with severe CLD requiring nasal high-flow respiratory support.
Methods We reviewed our units’ clinical experience of delivering budesonide via the Vapotherm ventilation circuit to infants with established CLD using the Aeroneb Pro-X (Aerogen, Ireland) nebuliser.
Results 7 babies with severe CLD received nebulised budesonide since 2013. Median (range) birth gestational age was 26.9 (23.1–27.7) weeks, birthweight 720 (490–850) g. Nebulisation commenced at age 62 (29–104) days postnatal, by which time 6 babies had accumulated 33 (10–49) days’ systemic dexamethasone. Initial budesonide dosage was 0.5 mg/dose administered 2–4 times/day. Duration of nebulisation prior to discharge/back transfer was 55 (9–69) days. Nebulisation permitted successful weaning from dexamethasone within 8 (0–20) days in 6 babies and obviated the need for systemic dexamethasone in another. After starting nebulisation, no baby needed a subsequent oral dexamethasone course before discharge/back transfer.
Conclusion Use of a new-generation electronic micropump nebuliser for topical airways budesonide delivery to nasal high-flow dependent infants is feasible and may avoid the need for systemic dexamethasone. The comparative safety and efficacy of this new technology for steroid delivery to ventilatory support-dependent CLD babies should now be formally examined in clinical trials.