The use of inhalers for treatment of asthma is becoming increasingly popular in children. However there is no standardised technique for maximum efficacy in the use of these inhalers. A recent Australian study of 2-7 years old children (Aerosol Inhalation From Spacers and Valved Holding Chambers Requires Few Tidal Breaths for Children. Pediatrics 2010;126;e1493-e1498) gives the following conclusions
· that normal breathing (tidal breathing) is best – in fact the tidal breaths taken were quite large compared to predicted tidal ventilation, probably influenced by the spacer itself.
· Single strong breathing in (maximal inhalation) was no better than normal breathing.
· There was little difference between the spacers tested (Aerochamber, Funhaler, Volumatic, or modified soft drink bottle)...(not even Coca Cola or Pespsi)
· There was no increase in drug delivery beyond that achieved with 2 tidal breaths for a small volume spacer, and 3 for a large volume spacer.
My recommendation still remains at a single puff from the inhaler into the spacer followed by 6-8 normal breathing (what to do, I am kiasu), followed by another puff and 6-8 breaths using a spacer.
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