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Inhalation therapy in children with asthma
1Department of Paediatrics, Isala Klinieken/Weezenlanden Hospital, GM Zwolle, The Netherlands. P.L.P.Brand@isala.nl
Insights
For children with asthma, metered dose inhaler (MDI)/spacer combinations are preferred over nebulizers for young children. Proper inhalation technique is crucial for effective asthma treatment in all children.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Asthma Management
Background:
- Current guidelines recommend inhalation therapy for all pediatric asthma patients.
- Effective delivery of inhaled medications is critical for asthma control in children.
- Various inhalation devices exist, each with specific technical and practical considerations.
Purpose of the Study:
- To review published evidence on the technical and practical aspects of inhalation therapy in children with asthma.
- To compare the efficacy and usability of different inhalation devices for pediatric asthma patients.
- To provide guidance on device selection and technique optimization for children with asthma.
Main Methods:
- Systematic review of published literature on inhalation therapy in pediatric asthma.
- Analysis of studies comparing nebulizers, metered dose inhaler (MDI)/spacer combinations, and dry powder inhalers (DPIs).
- Evaluation of factors such as device effectiveness, ease of use, and lung deposition.
Main Results:
- Metered dose inhaler (MDI)/spacer combinations are as effective as nebulizers for bronchodilator delivery in young children and are easier to operate.
- Plastic spacers can be improved by washing to reduce static charge, enhancing medication output.
- Most children aged 6 years and older can reliably use dry powder inhalers (DPIs), with variations in lung deposition between devices like Turbuhaler and Diskus.
- A significant number of children exhibit poor inhalation techniques, underscoring the need for proper training.
Conclusions:
- Metered dose inhaler (MDI)/spacer combinations are the preferred choice for inhalation therapy in young children with asthma.
- Dry powder inhalers (DPIs) are suitable for older children, but device-specific techniques must be mastered.
- Consistent instruction and repeated assessment of inhalation technique are essential for successful asthma management in all pediatric patients.
Abstract:
Current consensus guidelines advocate the use of inhalation therapy for all children with asthma. In this paper, the published evidence on technical and practical aspects of inhalation therapy in children with asthma is reviewed. For children under 6 yr of age, nebulizers and metered dose inhaler (MDI)/spacer combinations can be used. Nebulizers are cumbersome, bulky, and difficult to operate. They require technical and hygienic maintenance. A number of studies has shown that nebulizers are no more effective in delivering bronchodilator therapy than MDI/spacer combinations. Thus, for young children with asthma, MDI/spacer combinations are the device of choice for inhalation therapy. Due to static charge, the output from plastic spacers is lower than that from metal spacers. Static charge on plastic spacers can be reduced by washing the spacer in detergent and allow it to drip dry. Most children aged 6 yr or over can use a dry powder inhaler (DPI) reliably. Modern DPIs require relatively low inspiratory flow rates for proper operation. Lung deposition from the Turbuhaler is twice as high as that from the Diskus, but the former device is slightly more difficult to operate than the latter. Many children with asthma have a poor inhalation technique. Because a reliable inhalation technique is the key to successful inhalation therapy, inhalation technique should be instructed carefully and checked repeatedly in every asthmatic child using an inhaler device.