Inhalers and other drug delivery devices
Metered Dose Inhaler
Different devices are used in asthma – the aim of the device is to deliver the drug to the lungs as efficiently as possible. An adult or older child can use a standard inhaler, sometimes called a metered dose inhaler. This delivers a puff or spray of medication when pressed. Breathing in and pressing the inhaler have to be co-ordinated so the spray is breathed into the lungs rather than landing in the mouth. A demonstration can be viewed here -: http://www.asthma.org.uk/using_your_inhaler.html. (Link provided with kind permission of Asthma UK).
Spacer Devices, masks and mouthpieces
In young children, metered dose inhalers are still used but with a spacer device to overcome the need to co-ordinate breathing in and pressing the inhaler at the same time. The child breathes normally in and out through a mask or mouthpiece into the spacer device. The reservoir of air inside the spacer contains a puff of medication that is breathed in and delivered to the lungs. In the under 5s, the parent will usually need to hold the spacer and actuate or press the inhaler to release a spray of medication. A demonstration can be viewed here -: http://www.asthma.org.uk/using_your_inhaler.html. (Link provided with kind permission of Asthma UK).
Dry powder inhalers and breath actuated inhalers
Other types of inhaler include dry powder inhalers which deliver a spray of powder rather than aerosol. Some of these are breath actuated – this means that breathing in actuates the dose of medication and co-ordination is not required. Children can usually use these with minimal supervision from age 8. A demonstration can be viewed here: http://www.asthma.org.uk/using_your_inhaler.html. (Link provided with kind permission of Asthma UK).
All of the devices are simple and straightforward to use and take a few minutes on each occasion.
Nebulisers
Nebulisers are more time consuming. Nebuliser drugs are supplied in packets of individual doses. Each individual dose may need to be mixed with nebuliser solution for use. Whether mixing is required or not the individual dose has to be decanted into the reservoir of the nebuliser and the machine switched on. The dose is delivered by mask over around 15 minutes. The parent will need to supervise to ensure that the whole dose is delivered and that the child keeps the mask on through out the period. The nebuliser machine itself needs to be carefully maintained and serviced. Check that a nebuliser is being used by looking for evidence of prescription of drugs for use with the nebuliser. These include nebuliser or respirator solution and Salbutamol nebules or equivalent.
If a nebuliser is being used to deliver low dose steroids it is usually because the child is very un-cooperative with standard treatment or for some other reason often related to disability. It is a marker of significant care needs. There is only one type of nebulised steroid available called ‘pulmicort respules’.
