Making a good match between a young patient and an inhaler device is a first step toward optimal asthma management. Find a brief review of how to make that match in this short slide show.
Pressurized metered dose inhalers, pMDI-spacer combinations, breath-actuated inhalers, and dry powder inhalers are all appropriate for pediatric use, but making the right match with the patient’s developmental stage is essential.
Finding the best match between patient and inhaler device and technique is essential for achieving asthma control. Delivery of drugs to the targeted lung areas depends on the inhaler type, the type of inhaled medication, and patient factors. Inhaler choice should be tailored to age group because psychomotor skills differ by age.
Many patients have trouble with the hand-breath coordination required to inhale enough medication to reach the peripheral airways. A valved holding chamber or spacer can help. Children aged â¥7 years and adults can also try a breath-actuated device. Requires breath-holding after inhalation to ensure optimal deposition of medication in small airways. Breath-holding of 5 seconds is suggested in children up to age 10 years.
Hand-breath coordination rarely an issue; almost anyone can manage. Reduces oropharyngeal side effects (eg, oral thrush, hoarseness). Spacer volume is important: higher aerosol concentration in smaller-volume chambers increases drug delivery to target areas.
Dose delivered through spacer varies by age and breathing pattern: Children up to age 7 get most benefit from small-volume spacers; most children aged â¥4 can use a spacer with a mouthpiece; children age
Breath-actuated inhalers may overcome hand-breath coordination problems. Dose released by relatively low inspiratory flow rate. Not recommended in children
Dry powder inhalers require rapid, forceful inhalation. Overcomes hand-breath coordination in children with adequate inspiratory flow. In younger children age 4-6, inspiratory force may be sufficient when child is well, but not during wheezing episodes. Variability of delivered dose is greater than for pMDIs. Novolizer (Sofotec GmBH & Co. KG, Frankfurt, Germany) has been recently developed and contains a feedback mechanism that helps the patient perform the correct inhalation process; contains budesonide, salbutamol, or formoterol.
Main questions to ask in choosing an inhaler: Is conscious inhalation possible? Children â¤6 years and those unable to consciously control inhalation technique should use a pMDI with spacer. Is the inspiratory flow sufficient? Children â¤6 years and those unable to forcefully inhale should not use DPIs or breath-actuated inhalers.
Choice of inhaler for a pediatric patient with asthma must account for several critical age-related factors, with psychomotor skills and inspiratory flow rate being the most important. Spacers added to metered dose inhalers, breath-activated devices, and dry powder inhalers all help ensure delivery of optimal medication to targeted airways.The short slide show above reviews recommended inhaler types by age group and offers important reminders on patient evaluation.Â Â Please scroll down for reference.
Aalderen WM, Garcia-Marcos L, Gappa M, et al. How to match the optimal currently available inhaler device to an individual child with asthma or recurrent wheeze. Prim Care Respir Med. (2015) 25:14088; doi:10.1038/npjpcrm.2014.88. published online on January 8, 2015