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The ADMIT series--issues in inhalation therapy. 5) Inhaler selection in children with asthma
Søren Pedersen1, Jean Christophe Dubus, Graham K Crompton
1Pediatric Research Unit, University of Southern Denmark, Kolding Hospital, Dk6000, Kolding, Denmark. spconsult@post1.tele.dk
Insights
Many children with asthma struggle with inhaler technique, limiting treatment effectiveness. Focusing on simpler devices like metered-dose inhalers (MDIs) with spacers or dry powder inhalers (DPIs) improves asthma management for pediatric patients.
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.
Abstract:
Many children with asthma do not use their inhalers correctly and consequently gain little or no therapeutic benefit from the treatment. The focus of inhalation therapy should be on those inhalers which are easiest to use correctly by various groups of children and the amount of tuition and training required to obtain a correct technique. It is recommended that clinicians focus on a limited number of inhalers. Most children can be taught effective inhalation therapy by using a pMDI, a pMDI with a spacer ,or a DPI. Most preschool children can be taught effective use of a pMDI and spacer with a valve system and a face mask. Therefore, this is the preferred mode of delivery in these age groups. When the child is capable of using the spacer without a face mask this administration technique should be adopted. In older children pMDIs are more difficult to use correctly than a pMDI with a spacer, a DPI ,or a breath-actuated pMDI. Because DPIs and breath-actuated pMDIs are more convenient to use these devices are normally considered the preferred inhalation devices in these age groups except for administration of beclometasone dipropionate, which for safety reasons should be delivered by a spacer.
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