Kids & Aerosol Therapy

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Kids are fantastic little creatures— playful, curious, and sometimes a hell of an asthmatic patient. There are times when you can properly seek medical attention and voila! Your kid’s up and at it again with their utmost playfulness and curiosity. But sometimes, you’ve gotta do the asthma-relief treatment yourself. Now you’ve got to be prepared when your little asthmatic’s got the wheezey peezies. It ain’t easy bein’ wheezy, aye?

 

You’ve got your fair share of ready bronchodilators for quick relief— be it a/n albuterol/salbutamol puff or nebule+nebulizer combo. Now comes the question: which would work best?

Let’s start with our favorite, almost symbolic, weapon-of-choice: the Metered Dose Inhaler (MDI), more commonly known as the “puff”. Now, the MDI is the preferred method for aerosol therapy delivery for your ordinary everyday asthmatic since, well, you can just fit the damn thing in your pocket. Kids love it too, since it only takes one or two puffs (without the hassle of using a mouthpiece or a mask) and the kid’s up and at it again, climbing the furniture and breaking vases.

Puffs with a spacer is good for kids older than 4 years of age, while kids less than 4 years may have to use a holding chamber + mask combo. Kids 5 years old and above could use breath-actuated MDIs, and the same concept goes for DPIs. These guidelines assure effectiveness of the aerosol therapy. Heck, it’s so effective for kids that it’s just as good as a nebulizer (if proper technique is practiced)… that is, unless the asthmatic exacerbation is severe. Here comes the role of your bullet-like nebules loaded into that handy-dandy, whirr monster of a nebulizer.

 

Wait, you don’t know what a nebulizer is? Well, a nebulizer is a machine that makes the liquid medicine in the nebules form a mist to inhale for a couple of minutes. It’s preferred mostly for kids having either severe asthma attacks and are not compliant to the coordination process of an MDI. Also, it’s also handy when it comes to young kids on account of, well, their lack of coordination in the puff-inhale process of an MDI. A nebulizer with a mouthpiece may be used for children three years and up, but if they’d tolerate a mask (and are compliant to it), then a mask may be used.

 

It’s argued, though, that mouthpieces are the best delivery method for nebulizations on account their direct delivery to the lungs upon inhalation. The only problem with it is that some children may not know how to use it properly (i.e. sticking their tongue into the mouthpiece hole). This is where the mask would play a role, in which the mask holds the aerosol within close contact upon expulsion from the device’s outlet, and allowing the child to maintain their own respiratory cycle and inhale the medication. Now if that fails due to circumstances which cannot be controlled, like with kids suffering claustrophobia, a mouthpiece may be used to direct the aerosol to the kid’s nose (or mouth) which they may inhale. The problem with this method is, they also may not inhale the aerosol and deem the therapy ineffective.

 

Considering all these factors, the method of delivery is purely dependent on the technique mastery of the one delivering the aerosol therapy, the child’s compliance to the modality of the therapy, the situation and availability of such modalities, and the recommendation of the child’s physician. It is always best to seek professional medical advice, with an assessment of the child and what works best for them. After all, the therapy is for the child, and whatever works best for them in terms of the greatest delivery of therapy would always be deemed best.

 

Source:

·         Ari, A. (August 2009). Optimal Delivery of Aerosol Drugs in the Pediatric/Neonatal Patient Population. American Association of Respiratory Care Times

·         Pruit, B. (August 2008) Kids and Asthma: Making (and Teaching) the Right Choices. RT Magazine