Asthma is one of the most common conditions I seen in my practice day to day. One of the most important factors in the success of an asthma treatment plan is medication delivery. The majority of asthma medications are inhaled, and giving an inhaled medication is tricky in a child. If you give a child a medication by mouth, you have an idea how much they got. Maybe it went down their throat; maybe it’s on your shirt. With an inhaled medication, technique is critical in ensuring your child gets the medication correctly as you can’t tell visually if he or she has inhaled the medication. If the medication is given incorrectly, a lack of improvement may lead to an incorrect diagnosis. Or it may lead to increased side effects– if an inhaled steroid is taken without a spacer, more of it will be absorbed through the mucus membranes to thrush (a benign fungal infection) or even weight gain. More commonly, a higher dose than necessary may be prescribed. As I discussed previously, you always want the minimum effective dose.
Many children are initially prescribed asthma medication via a nebulizer. This is essentially an air compressor which makes the medication into a mist which is inhaled by a child. I don’t like nebulizers much for kids over a year; kids don’t sit still long enough for effective treatment. Some parents find nebulized albuterol to be more effective during an upper respiratory infection. This video is from the St. Louis Children’s Hospital.
I prefer delivery of inhaled asthma medications via an inhaler, or puffer (commonly abbreviated as a Metered Dose Inhaler (MDI) with a spacer. A spacer is a tube with a valve on it which contains the medication until the patient is ready to inhale. (It is the yellow tube with the mask , below.
I recommend a spacer for all of my asthma patients. If the inhaler is placed in the mouth, much of the medication will be deposited in the throat and not the lungs unless the inhalation is timed perfectly. The spacer contains the medication until the patient is inhaling so the technique does not have to be perfect.
This is a video from Healthychildren.org showing how to use a mask/spacer, which I routinely use in 1-6 year olds. When the narrator says “tidal breathing,” he just means normal breathing. If your child cries they will still get the medication. However, with consistent use, they will usually stop crying over time.
I love this video of an 11 month old taking her medication via a spacer. She takes such pride in doing it correctly! Also, her parents do a great job of coaching her.
An older child can use the device with a mouthpiece instead of a mask:
It’s important to rinse your child’s mouth out afterwards to avoid thrush. If a mask is used for steroids via nebulizer or inhaler and spacer, wipe off your child’s mouth as well. Practice will ensure proper medication delivery. Whenever your child is prescribed an inhaled medication, make sure you understand how to give the medication before you leave the office. Effective technique will ensure that your child has good asthma control.
NB the link to the initial video came from Dr. Ves at how-to-use-your-asthma-inhalers.html.