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Inhaler use in children with asthma
1Department of Paediatrics, Aalborg Hospital North.
Insights
Children can learn effective inhaler use, but proper instruction is key. Simplifying techniques for metered-dose inhalers (MDIs) and dry powder inhalers (DPIs) improves adherence and therapeutic outcomes in pediatric respiratory care.
Area of Science:
- Pediatric Respiratory Medicine
- Pharmacology and Therapeutics
- Medical Device Technology
Background:
- Inhaler devices are crucial for delivering respiratory medications to children.
- Effective use of inhalers by children is often hindered by technique-related challenges.
- Optimizing inhaler technique is essential for maximizing therapeutic efficacy in pediatric patients.
Purpose of the Study:
- To identify common problems children face with different inhaler devices.
- To evaluate the effectiveness of various inhaler techniques and devices in pediatric populations.
- To simplify inhalation techniques for improved adherence and outcomes in children.
Main Methods:
- Review of existing literature on pediatric inhaler use and techniques.
- Analysis of common errors associated with metered-dose inhalers (MDIs) and dry powder inhalers (DPIs).
- Comparison of the efficacy and usability of different inhaler systems, including the spacer (TS) and Rotahaler (RO).
Main Results:
- Coordination issues and inhalation timing are primary problems with MDIs, while loading and capsule splitting challenge DPIs.
- Most children over five can master inhaler use with adequate training, which is retained with regular use.
- Spacer devices (TS) facilitate slower inhalation and reduce coordination problems compared to standard MDIs.
- Powder inhaler effectiveness depends on inspiratory flow rate, posing risks during acute wheeze or in children with low pulmonary function.
- Simplified instructions for inhaler use can be implemented without compromising therapeutic effect.
Conclusions:
- Insufficient patient education is a significant barrier to effective inhaler use in children.
- Spacer devices may offer advantages in simplifying MDI use for children.
- Inhaler technique simplification and tailored instructions are vital for improving treatment outcomes in pediatric respiratory conditions.
Abstract:
1. Coordination difficulties, stop of inhalation at actuation and fast inhalations are the most important problems children experience when using a PA while difficulties with correct loading and splitting of the capsule are the most prevalent problems with the RO. 2. Most children older than 5 years can be taught effective use of an inhaler and once the correct technique has been learned is it rarely forgotten if the inhaler is used regularly. 3. Insufficient instruction at the time of prescription is the major cause of inefficient inhaler use in children who use their inhalers regularly. 4. Use of a TS makes it easier for children to inhale slowly. Furthermore, compared with a PA and TS reduces the occurrence of coordination problems and stop of inhalation when the aerosol is fired; otherwise there seems to be little clinical difference between a PA and a TS. 5. Problems with correct inhaler use are accentuated during episodes of acute wheeze when supervision or help from an adult may be needed. 6. Pauses between doses of inhaled bronchodilators are likely to improve bronchodilation during episodes of acute wheeze, whereas there is no need to recommend pauses between the puffs of bronchodilators or between puffs of bronchodilators and corticosteroids in the routine day to day management of patients. 7. Children using a TS should be taught to inhale as slowly as possible. Tilting the head back during inhalation, breath-holding after the inhalation and exhalation through the nose do not enhance response. Furthermore, the lung volume at which the aerosol is actuated is relatively unimportant as long as the child inhales as deeply as possible after actuating the aerosol. 8. The effect of powder inhalers is dependent upon a certain inspiratory flow rate and therefore there is a risk of reduced effect during episodes of acute wheeze or in children with low pulmonary function. This risk may be greater with a RO than with a FPI. 9. Children using a Rotahaler or a Fenoterol powder inhaler should be taught to inhale as fast as possible. They need not tilt the head backwards during inhalation or hold their breath afterwards. 10. Conclusions from one inhaler should be applied with caution to other inhalers. 11. The long list of instructions currently considered to represent the essentials of correct inhalation technique can be markedly simplified without any significant loss of effect in children receiving inhaled therapy with bronchodilators and corticosteroids.(ABSTRACT TRUNCATED AT 400 WORDS)