For children with asthma, inhaled medicines are an essential component of their treatment plan. To be effective, the inhalers, technically called metered-dose inhalers (MDIs), must be used properly. Children who use spacers (tubes that are placed between the MDI and the lips) with their MDIs get a lot more of the inhaled medicine into their lungs than children who just use an MDI.
Proper use of MDIs with spacers starts with shaking the MDI several times. The child exhales completely. Next, he gently but firmly places his lips around the mouthpiece. He then squeezes the MDI, releasing the medicine into the spacer, followed by inhaling slowly and completely. He should then hold his breath for a count of ten, and then exhale.
There are a number of ways the spacer improves the delivery of the medicine to the lungs. Perhaps the biggest problem children have with using MDIs is that they don't aim it properly. The medicine, rather than becoming aerosolized, ends up squirting onto the top of the child's mouth or the back of his throat, causing choking and gagging. The spacer eliminates this problem by aerosolizing the medicine in the spacer. The child then breathes in the aerosolized medicine. The "aiming" problem is eliminated and more of the medicine gets into the lungs.
Another way to aerosolize the medicine is with a nebulizer. A nebulizer mixes an inhaled medicine with water, making a mist. They are most frequently used when an asthmatic is being treated in the emergency departments or while hospitalized. The belief is that nebulized medicine gets into the lungs better than any other way.
Recent studies have found that an MDI with a spacer is just as efficient at delivering the medicine to the child's lungs as using a nebulizer. The Guidelines from the Global Health Initiative for Asthma recommend an MDI with a spacer and a face mask for infants and preschool children, an MDI and spacer with a mouthpiece for children four to six years old, and a dry powder device or breath-activated device for children over six years old. The researchers believe there's no routine need for nebulizers. The problem is convincing parents and doctors that an MDI with a spacer is as effective a way of delivering the medicine as a nebulizer.
The Journal of Family Practice, 1/04, pp. 55-57.
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