Wednesday, January 26, 2011

Children, Inhalers and Spacers

The use of inhalers for treatment of asthma is becoming increasingly popular in children. However there is no standardised technique for maximum efficacy in the use of these inhalers. A recent Australian study of 2-7 years old children (Aerosol Inhalation From Spacers and Valved Holding Chambers Requires Few Tidal Breaths for Children. Pediatrics 2010;126;e1493-e1498) gives the following conclusions

· that normal breathing (tidal breathing) is best – in fact the tidal breaths taken were quite large compared to predicted tidal ventilation, probably influenced by the spacer itself.

· Single strong breathing in (maximal inhalation) was no better than normal breathing.

· There was little difference between the spacers tested (Aerochamber, Funhaler, Volumatic, or modified soft drink bottle)...(not even Coca Cola or Pespsi)

· There was no increase in drug delivery beyond that achieved with 2 tidal breaths for a small volume spacer, and 3 for a large volume spacer.

My recommendation still remains at a single puff from the inhaler into the spacer followed by 6-8 normal breathing (what to do, I am kiasu), followed by another puff and 6-8 breaths using a spacer.


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