By Chris Woolston
Whether your child is an infant or a teenager, an inhaler can be a vital part of the program for keeping his asthma under control. There are two main types of asthma medications: the first type is used regularly to prevent attacks by delivering anti-inflammatory drugs (it's known as a controller); the other, called a bronchodilator, is used to open airways when an attack is under way (it's known as a reliever). Both of these types of medication can be delivered using an MDI (Metered Dose Inhaler), often called a puffer, which has an advantage in that medication is delivered directly into the lungs.
The style of inhaler your child uses depends on his age. Your child's doctor will explain how to operate it, but here are a few basic tips for different age groups:
Infants and Toddlers
Up to age 3, children generally use what's known as a nebulizer. This requires a machine that breaks liquid medication into very small particles so that they can be inhaled. The nebulizer can be used with a mouthpiece or with a mask (for small children a mask is preferable). The nebulizer gives continuous medication (more than one type of medication can be mixed together), and works best in children less than 3 years old and for older children who are having an acute asthmatic attack and cannot use an MDI.
Medication for use in a nebulizer comes in two forms. In one method, the exact dose of medication to be added to the "cup" of the nebulizer is available in unit dose vials. In the other, large bottles of medication generally come with a calibrated dropper so that you can place the correct amount of liquid in the nebulizer. Your doctor will tell you the correct amount of medication to use and the number of times a day your child should use each medication. (He or she will also give you information about how to use the nebulizer if your child has an asthma attack.)
Start by adding the correct medication(s) to the nebulizer cup. Connect the tubing to the machine and then turn it on. Place the mask over your child's nose and mouth and make sure that it is comfortable (this may take some time to get used to). Your child need only breath normally until all of the medication is removed from the nebulizer cup.
Some children under the age of 4 may be trained to use a Metered Dose Inhaler, although this is uncommon. The best method is to use a spacer with a mask (Aerochamber with a mask is one type). Start by placing the canister bottom up in the plastic holder, then removing the cap from the inhaler. Shake the canister before each dose (this is important). Reassure your child so he doesn't feel scared, then place the mask over his mouth and nose, making sure it's sealed tight. (If your child seems anxious, you might demonstrate on yourself first.) Release a puff of medicine by pressing down on the canister. Hold the mask in place until your child has taken at least six breaths.
Ages 4 to 8
Your youngster may no longer need a mask, although some 4-year-olds will still need it. However, all children should use an MDI with a spacer for best results. (Your doctor or health care professional can show you the different types and suggest one best suited for your child.) Children in this age group use the canister and plastic holder in the same way as described above. Have your child put his lips snugly around the mouthpiece of the spacer, with his teeth apart and his tongue out of the way. Activate the MDI, then ask him to breathe in slowly and deeply, and then hold this breath in his lungs for five to 10 seconds. Exhale, and then, with the mouthpiece still in place, have him breathe in deeply and hold his breath again to get the full benefit of the medicine.
Over Age 8
Your child can use either a standard metered-dose inhaler or a dry powder inhaler. Doctors recommend using a canister and spacer as described above, but your child can also try simply holding the inhaler one to two inches from his open mouth. (If he has trouble using it this way, he can also try putting the inhaler directly in his mouth with the lips open.) As he presses down on the canister to release the medicine, he should start breathing slowly, taking several seconds to inhale, then hold his breath for 10 seconds.
To use a dry powder inhaler, your child should simply put his mouth around the mouthpiece and inhale quickly and deeply. Many children and their parents prefer this type of inhaler, and a study published in the Journal of Allergy and Clinical Immunology found that almost all children over age 8 quickly learn how to use it.
National Library of Medicine. Inhaler Medication Administration.
American Lung Association. Five Asthma Medication Groups.
Cincinnati Children's Hospital Medical Center. Metered-Dose Inhaler.