Dr.Kamini Silvarajan MD/AAAM

Editorial Board: Dr.Kamini Silvarajan MD/AAAM

Asthma Inhalers Children

Inhaler With A Spacer

Asthma inhalers are the easier way to get asthma medications to a child’s lungs. While a nebulizer might be convenient to use, many parents and kids do not like the lengthy time it takes to deliver an asthma treatment.

While more convenient asthma inhalers must be used properly, requiring caution, if they are needed to be effective. That can be simplified by combining a asthma metered dose inhaler with a spacer or a spacer with a mask, but this too must still be used correctly.

An asthmatic will not be able to get away from using an asthma inhaler as some asthma medications are only available as an inhaler. For example, while there are nebulized forms of Albuterol, Levalbuterol (Xopenex), and Pulmicort (Budesonide), most other medications to treat asthma are only available as inhalers.

Asthma Inhalers And Their Types

Mainly there are two types of asthma inhalers, including the older metered dose inhalers (MDI) that many people are familiar with, and the newer dry powdered inhalers (DPI). Generally, most people think that dry powdered inhalers are easier to use because they are breath actuated ,meaning medicine doesn’t come out until you take a breath,while metered-dose inhalers require the user to coordinate taking a deep breath with activating the inhaler. 
  1. metered dose inhalers with Chlorofluorocarbons(CFC) have been phased out because of environmental concerns
  2. metered-dose inhalers – the newer CFC free Hydrofluoroalkane (HFA) propellant inhalers
  3. breath actuated metered-dose inhalers (HFA) are more expensive than other MDIs
  4. dry powdered inhalers – generally can’t be used until children are at least five to six years old and can take a deep forceful inhalation.Younger children often try to blow into the inhaler, instead of breathing in.

Many younger children make these mistakes when using a Dry Powdered Inhaler:-

  1. positioning the inhaler incorrectly
  2. forgetting to exhale fully before using the inhaler
  3. not taking a deep, forceful inhalation
  4. not holding their breath for about ten seconds as a requirement
  5. forgetting to breathe out slowly afterward
Of course, it is common to make mistakes with metered-dose inhalers, too. A common mistake is for kids to forget to take a slow, deep inhalation, breathing in too fast instead.

Inhalers with Spacers

When your child are able to use a metered dose inhaler once he is about six years old, it can still be a good idea to use a spacer to make sure he gets the full dose to his lungs.

A spacer is a small device that can be attached to an inhaler and can even include a mask for infants, toddlers, and preschoolers who are four years old or younger. They include a holding chamber that keeps the medicine in the spacer until your child takes a breath, so that he doesn’t need to coordinate taking a breath with activating the inhaler.(see diagram below)

Asthma inhaler spacers vectors

Rescue Asthma Inhalers

Rescue asthma inhalers include Short Acting Beta Agonists or SABA that can provide quick relief when your child is having asthma symptoms:- 

  1. ProAir HFA (albuterol inhaler)
  2. Proventil HFA (albuterol inhaler)
  3. Ventolin HFA (albuterol inhaler)
  4. Ventolin HFA 60 (albuterol inhaler)
  5. Xopenex HFA (levalbuterol inhaler)
  6. Maxair AutoHaler (pirbuterol inhaler) – a breath actuated MDI
Note:- HFA – HydroFluoroAlkane

These rescue asthma inhalers are typically only used on and as a needed basis and not daily.Consult your pediatrician if your child seems to need to use his/her quick relief asthma medication more than about two times a week.
Preventative Asthma Inhalers

Inhaled corticosteroid inhalers are main inhalers of asthma preventative therapy.Whereby rescue inhalers, which can give quick relief for asthma symptoms, steroid inhalers are typically used on a daily basis to help prevent your child from developing asthma symptoms.

Although it may seem like steroid inhalers are all the same, the particle size of the drug can affect how they are absorbed. Generally, those with a small particle size, like Aerobid, Alvesco, and Qvar, are supposed to get deposited better in the lungs, statistically.

Perhaps more essential than particle size is simply obtaining a steroid inhaler and using it properly daily:- 

  1. Aerobid (flunisolide) – an MDI approved for children who are at least six
  2. Alvesco (ciclesonide) – an MDI approved for children who are at least twelve
  3. Asmanex Twisthaler (mometasone) – a DPI approved for children who are at least twelve
  4. Flovent Diskus (fluticasone) – a DPI approved for children who are at least four
  5. Flovent HFA (fluticasone) – an MDI approved for children who are at least four
  6. Pulmicort Flexhaler (budesonide) – a DPI approved for children who are at least six
  7. Qvar (beclomethasone) – an MDI approved for children who are at least five
Each inhaler is available in multiple strengths to help get your child’s asthma under good control. If a low dose inhaler isn’t working, then moving up to the higher dose might, for example, moving up from Qvar 40 to Qvar 80.

For children with moderate to severe asthma who are not able to control with an inhaled steroid, then an inhaler that combines a steroid with a Long Acting Beta Agonist or LABA can be helpful. 

These inhalers include:- 

  1. Advair HFA – (Flovent + Serevent) – an MDI approved for children who are at least four
  2. Advair Diskus – a DPI form of Advair – approved for children who are at least four
  3. Dulera – (Asmanex + Foradil) – an MDI approved for children who are at least twelve
  4. Symbicort – (Pulmicort + Foradil) – an MDI approved for children who are at least twelve
Once your child’s asthma is well under control while using a combination inhaler, talk to your pediatrician to see when it might be time to step down your child’s therapy so that he is only using a steroid inhaler. 

Remember consultation is very important not only usage.

Know about Your Asthma Inhalers

Normally, the most essential thing to know about your child’s asthma inhalers is that you should keep using them until you are told by your pediatrician to stop them. An asthma action plan can help to make sure you know when to use your child’s asthma inhalers and regular follow up appointments. 
Take along all of your child’s asthma inhalers with you when you see your pediatrician so that they know what medicines your child is taking and so that your child can demonstrate how good or poor his technique is with his inhalers. 

Asthma inhalers can be expensive and the cost can be a factor that influence which inhaler your child uses. 

In addition to being compact and portable, using an asthma inhaler is much faster than a treatment from a nebulizer. 

Many asthma inhalers are used off label and against recommended guidelines in kids who are much younger than the ages for which they are approved.This is another factor which might aggravate the asthma treatment plan in children. 

Engage a heart to heart conversation with your pediatrician if you can’t afford your child’s asthma inhalers. Pediatricians often have samples and coupons for asthma inhalers or may be able to assist you with the prescription assistance programs that many drug companies now offer.

“We should not lose face cause it’s our child anyway,if it’s not we who else will”

Keep in mind that while many experts believe that an MDI with a spacer is as good as a nebulizer treatment, some parents prefer a nebulizer.

DISCLAIMER :– The information contained above are for educational and basic guide purposes only, and should not be used as a substitute for any ASTHMA personal care. Please see your medical healthcare providers for diagnosis and treatment of any concerning symptoms or medical condition and asthma medications.