“Mom, I can’t breathe,“ gasped my son when I picked him up from football practice on Wednesday evening. I checked his vitals (my hand on his forehead for body temperature, my fingers on his wrist for pulse rate). No fever, slightly racing pulse, labored breathing with a wheezing sound. He was having an asthma attack.
He hasn’t had that for over 3 years now and not this bad so I wasn’t prepared for it. At home, I checked his inhaler and found the drug has expired in June 2010. Also, I couldn’t find the mask that went with it. So I administered his asthma medicine directly into his mouth that night and took him to the doctor first thing in the morning where we got a inhaler and a delivery device. When I asked the doctor about direct delivery into the mouth, he said that such method does not work effectively on kids.
What people see on films about asthmas and inhalators are people simply sticking the stuff into their mouths and press.
In real life, administering asthma drugs, especially in kids, is not that straightforward and there are too many delivery devices out there to confuse not only the adults but most especially the pediatric patients.
A study by British researchers noted:
“…when a child with asthma taking prophylactic steroids is seen in clinic or the accident and emergency department for the first time the parents are often unsure which inhalational devices the child uses. If the child is not taking steroids by nebulisation the clinician has a 1 in 125 chance of guessing the correct combination of inhalation device, drug, and strength of inhaler that the child is using. It should be possible to devise a simple prescribing strategy that would avoid this confusion. “
The researchers also pointed out that these devices are distributed as promotional products from asthma drug manufactures and may not have been really tested for effectiveness. Those devices which are marketed as such may provide insufficient information to help doctors make “an informed choice.”
Another problem, according to a recent review, is that
“…there are no inhalers on the market that have been specifically designed to meet the unique needs of children because most inhalers were developed for adults and then used for the treatment of children following minor modifications.”
An ideal device for kids should be easy to use and delivers consistent doses of the drug without being too expensive.
I decided to do some research on the different delivery devices.
Nowadays, the most common delivery devices for asthma medications for kids are the so-called spacer devices and our doctor gave my son one of these. They may or may not come with a mask. As a baby, my son had to use a spacer with a mask. I was lucky that he didn’t refuse it. I have heard of kids refusing to have the device covering their mouth and noses. The new device that the doctor gave us has no mask but a mouthpiece that my son could place in his mouth (see blue device in the picture). In addition, he also gave my son a practicing piece of the next delivery device, a much smaller one (see red device in the picture) for older kids.
My son’s spacers, with or without mask have some disadvantages, as follows:
- They are big and bulky and wouldn’t easy fit in a child’s schoolbag, much more a jacket pocket.
- They are made of plastic, creating problems of static charge that causes dose variability. Our doctor instructed me to wash the spacer in detergent at least once a week to overcome this problem.
The other device that he is practicing on (and he is doing a good job!) and is much smaller and can fit easily in his jacket pocket. Hopefully, he will be able to use this small device soon.
The other common device used is the nebulizer which allows delivery of big doses, especially during severe attacks. Fortunately, my son hasn’t had to use this so I never had the chance to check it out although it seems to be even bulkier and more complicated to use than the spacers. I’ll do some research on the nebulizers and update you next time.
In the meantime, check out the following resources: