The ADMIT series--issues in inhalation therapy. 5) Inhaler selection in children with asthma

Area of Science:

• Pediatric Pulmonology
• Respiratory Medicine
• Asthma Management

Background:

• Incorrect inhaler use is common in children with asthma, reducing therapeutic benefits.
• Effective inhalation therapy requires appropriate device selection and proper technique training.
• Optimizing inhaler use is crucial for improving asthma control in pediatric populations.

Purpose of the Study:

• To evaluate the ease of correct inhaler use among different age groups of children with asthma.
• To determine the training required for effective inhalation techniques with various inhaler devices.
• To recommend preferred inhaler devices and administration strategies for pediatric asthma patients.

Main Methods:

• Review of current literature on pediatric inhaler device usability and training requirements.
• Analysis of factors influencing correct inhaler technique in children of different ages.
• Comparison of metered-dose inhalers (pMDIs), spacers, dry powder inhalers (DPIs), and breath-actuated pMDIs.

Main Results:

• Preschoolers benefit most from valved holding chambers with masks, transitioning to spacers without masks as they mature.
• Older children find standard pMDIs more difficult to use correctly than pMDIs with spacers, DPIs, or breath-actuated pMDIs.
• Dry powder inhalers and breath-actuated pMDIs are generally preferred for older children due to convenience, with specific exceptions.

Conclusions:

• Clinicians should focus on a limited range of inhaler devices that are easier for children to use correctly.
• Metered-dose inhalers with spacers and dry powder inhalers are effective options for most children.
• Specific safety considerations, such as using spacers for beclomethasone dipropionate, must be prioritized.