The best treatment option for childhood asthma, which is presently not very uncommon in India, is to give inhaled corticosteroids as controller or preventer therapy. International Respiratory societies and working groups have recommended the use of inhaled steroids to achieve asthma control and improve quality of life (QoL) of these children over many years now.
There are several devices available in the market to take these inhaled medicines. However, pulmonologist recommend the use of a metered dose inhaler (MDI) with a valved spacer device as the best method of taking inhaled medicines.
What is an Inhaler?
An inhaler or MDI is a device that delivers a measured amount of medication with every puff to your lungs. It consists of a canister that holds the medicine, a metering valve that allows the desired amount of medicine to be delivered per puff and an actuator that directs the aerosolized medicine towards the mouth.
What is a spacer?
A spacer is a long tube that holds the inhaler at one end and has a mouth piece on the other end.
A spacer holds the medicine in the tube chamber for a longer time so that you don’t have to actuate the inhaler and breathe in at the same time.
The inner wall of the spacer is designed in a way that the medicine particles don’t stick to it. The valves present at the mouth piece prevent mixing of the medicine with exhaled air while taking the medicine.
With correct use of an MDI and spacer, approximately 25% of the medicine particles generated per puff is delivered to the lungs. This amount is sufficient to treat your lung condition.
What is a nebulizer?
A nebuliser is a device that delivers inhaled medicines in the form of a mist inhaled into the lungs. It uses compressed air, ultrasonic power or oxygen to break the liquid medicine and produce aerosol that is then inhaled into the lungs.
Why choose inhalers over nebulisers?
1. Inhalers are more efficient in delivering the medicine deeper into the lungs
The particle size of the medicine in an inhaler is <5microns as compared to a nebulizer where it can vary from <5 to 10 microns. The smaller the particle size, the deeper it can reach into the lungs. Therefore, with the MDI + spacer, better medicine delivery is achieved.
For controller treatment with inhaled corticosteroids, inhalers with spacer are the most effective method of medicine delivery
Nebulisers are helpful in delivering large doses of medicines in case of acute exacerbations in children with fast breathing to relieve the acute symptoms fast.
2. Inhalers require a lesser dose to be administered as compared to nebulisers
Inhalers with spacer deliver the medicine in the desired quantity when given in small doses as compared to a nebulizer. The same medicine that is given by nebulizer at a certain dose can be given at 1/4th dose by inhalers for achieving the same clinical effect.
3. Inhalers are more cost-effective
Inhalers are simple devices that have around 120 doses per canister. On an average one inhaler lasts for 2-3 months and doesn’t need to replaced frequently. The spacer device can also be used for 6months to 1 year if cleaned properly and regularly.
4. Inhalers with spacer are more convenient than nebulization
Inhalers are portable devices that are easy to carry, don’t take much space. They do not require any electricity or batteries. The time taken to give medicines with inhalers and spacer is around 1 minute, that is much less as compared to one nebulization that takes nearly 10 minutes.
