Asthma - How to use an inhaler

Male: Some kids are diagnosed with wheezing and asthma. In different approaches some people use nebulizers, some use inhalers and we know that you strongly advocate the use of inhalers and also spacers. Can you sort of like explain why if you have, the idea of using an inhaler in a young child especially, what can you improve, the effect in this, what devices could you use and what age is what you are talking to use an inhaler for? Female: Sure, so I prefer the inhaler. It is a personal choice over the nebulizer for reasons of portability and often just for ease of medication delivery as far as timing is concerned. Especially, when a child gets into their preschool toddler stage, it is much harder to give a 15 to 20 minute nebulizer treatment to have a child sit down still for that. So I actually prefer what we call the meter dose inhaler with the spacer. I always recommend using what we call a spacer or holding chamber with the meter dose inhaler. So your medication actually comes in what we call a meter dose inhaler and some older children and adults will use this without a spacer or a holding chamber. Male: If without a spacer, what technique can you demonstrate for the steps, so they are using it correctly, because lots of people just suck it in. They think it started. Female: So, I always recommend using a spacer or holding chamber regardless of age. Male: We would not do that without it? Female: Yes, so if for some reason you leave this at home or you dropped it and it cracks or for whatever reason, you don’t have your spacer, although we should but incase you don’t the technique used for this is not to actually put your lips on the meter dose inhaler. It is actually recommended that first you shake the meter dose inhaler well. We first recommend exhaling fully and then holding the meter dose inhaler, one to two inches away from the mouth and as you spray, you would inhale a deep slow breath. Hold your breath for 10 seconds and then exhale. Now again this is a technique that I don’t recommend without a spacer or holding chamber. However, if in the situation that you may not have… Male: Is the duration off, if you use a steroid inhaler? Female Absolutely. We recommend rinsing or even brushing your teeth after using an inhaled steroid because they can deposit on the insides of your cheek or the back of your throat and it can result into fungal infection. Male: So the ideal ways using some other device and you brought a couple with you. Could you explain the differences? Female: Yes. So, these are just different company brands but the important thing is that all of these spacers or holding chambers have one way valves on them that trap the medicine in size. So you put your meter dose inhaler on the opening here, and this is one with what we call a mouth piece that we use in older children and adults and the great thing about this is it traps all the medicine here. So, it is all waiting here fro you to inhale, where as in other techniques the medicine may disperse elsewhere. This guarantees that all your medicine is within this chamber before you inhale it. Again, similar to the technique I just reviewed without the spacer for older children and adults, we recommend either shaking it before you put it on the spacer or shaking once it is on here. Now here, there is a mouthpiece. You would put a good seal around it. We recommend breathing out first then puffing it. Doing a slow deep inhale, holding it for at least 10 seconds to allow the medication to deposit deep in you airways and then exhaling. Now, for younger kids that are able to use the mouthpiece, that may not be able to take that deep enough breath in and hold their breath for 10 seconds, there is a different technique that we recommend. And that is actually, still to shake it up. Place your mouth on here, puff it and take six regular breaths in and out and six regular breaths will empty this just as good as a big large breath would. And one thing that is nice about a lot of these spacers and holding chambers is that they will whistle if you are breathing too fast. So if you hear a whistle while you are doing it. This one actually, I don’t think the whistle is working on but if they do whistle that is a trigger for you to actually slow down that breath. Male: I have seen you recommend it for a baby. How could you use it on a baby? Female: So babies as well again, because as I mentioned, the medication is trapped here. For your younger children and infants, we use this in infants from newborn to about the age where they are able to use a mouthpiece. We use an attachment called the facemask and these come as small medium and large sizes. They actually have extra-small sizes to use on tiny babies and what we would do then is actually recommend. Again, shaking the medication, placing the mask over the child and holding it there, puffing this and then because you cannot tell an infant or a baby how to take six breaths in, you actually just wait for them to take six to ten of their regular breaths while actually emptying a one whole puff from this medication.