What is Asthma? Pt. 2

Host: If a child wheezes and they are very young, many pediatricians today give these kids a nebulizer, why? Michael Marcus: Nebulizer is a device which allows the medication to go from a liquid form into an inhaled or a mist form, thereby allowing the child to breathe the medication in. In certain conditions which results in wheezing, these inhaled medications actually help relieve the spasm in the lungs to improve the breathing, decrease the wheezing, and help the children breathe more easily. Host: Generally, kids under six months don't do as well with nebulization, kids under six months, is that true? Michael Marcus: That is correct. What we have learned is that there are group of children who wheeze, who do not respond nearly so well to the nebulizer medication, and six month is a very common cutoff for that. So under six months, we only give nebulizer medication if we have tested it on the child, and we see that they are a responder to that medication. Host: Years ago doctors used to get kids to wheeze epinephrine or adrenaline shots. Is there any place for that anymore? Michael Marcus: We generally do not use epinephrine or adrenaline shots at this point. What we have learned is that the inhaled medications work just as well as the shot of adrenaline, and its a lot less difficult for the child to receive. Host: We know some kids carry inhalers. What group of kids would be more likely that you would use an inhaler over a nebulizer; is that for older kids, or certain type of kids, what would that be? Michael Marcus: An inhaler is a device that administers medications into the lungs, in the same way that the nebulizer administers medications in a way that allows it to go into the lungs more easily. The choice of using a nebulizer versus an inhaler depends upon the child, their age, and their ability to do the medication administration properly. The metered dose inhalers and dry powder inhalers that we presently have require a certain amount of skill and practice for the child to perfect in order for the medication to reach the lungs in an effective manner. We generally use spacers attached to some of these device to help this technique, again, to allow the medication to be inhaled properly. What we do is we look at the child's age, we see if he is able to take these inhalers in a proper fashion, and if in fact they can, then we present it as an option. The advantage of the inhaler is two-fold. One, it's small, able to be placed in a pocketbook or a pocket or a briefcase, and therefore can go with the child wherever they are, allowing them to have these medication in a very simple fashion. The other is that the inhaler takes far less time than a nebulizer. In a matter of seconds they can have their medication in their lungs, where with the nebulizer, it may take anywhere from five to ten minutes, depending upon the specific device. Host: If a kid used an inhaler, what group or age group that you would probably consider them over a nebulizer? Michael Marcus: There are some children as young as seven and eight years old who can use an inhaler properly, and I have seen 12 and 13 year olds who are still not using it right and are still better off using a nebulizer. The nebulizer gives the medicine in an easier and more reliable fashion. It only has the inconvenience of taking longer to administer, and being required to have the machine with you if you need it on the road. Host: If you have an inhaler and they shake it, and they hear some noise, there seems some way, can we assure that there is medicine still inside that inhaler? Michael Marcus: It's tricky. There are some inhalers where we can judge if the medication is there just by the way it feels. There are others where it does not. You need to take a look at the specific instructions of the device. Each device has its own technique for telling whether you have any medication left or not. The rule of thumb, if there is any doubt, get a new device. Each device should last for up to a month. If you have been using your device for more than a month, you probably are going to need a new one. Host: The preventol or albuterol inhalers was a commonly used one, its 200 ml doses, so you probably should keep track of how many times you use this, is that correct? Michael Marcus: Ideally, if you can keep count, it will be quite helpful. 200 doses of the medication in the old albuterol is something that we understand to be administered, however keeping count of 200 doses over the course of the month, can sometimes be difficult. The other things to realize is that every time you use a test dose, a primer dose, it counts. So what we generally say is that if you are using the device for more than approximately a month, and you are using it regularly during that month, you are at the point where you are ready to get a new device. Host: A lot of times kids get medicine in school, and they have a bunch of inhalers, and what other devices is there, but no account seems to be taken; its in the locker and the nurse takes it out, so this may not be an ideal practice, isn't it? Michael Marcus: It's quite important that the person responsible for administering the medication be aware of how to judge if there is sufficient medication left. Having a device in a school, at a grandparent's house, at a babysitters, is important to allow for medicine to be administered at each of these sites, however the person responsible must keep track of the doses.