Nebulizer or inhaler: Which one works best for your child?

So you have an asthmatic child at home.  Chances are you also have quick-relief medicine, sometimes called "rescue inhalers" to give to him if he has an asthma attack.  If so, you should also be aware of the latest recommendations for administering this medicine.

Bronchodilator is the medication in quick-relief inhalers. The most common bronchodilators that provide instant relief to a child having trouble breathing are Albuterol and Xopenex (levalbuterol).  I think both these medicines work equally well, but some doctors and patients prefer one over the other.

There are two basic ways to deliver this kind of medicine: a metered dose inhaler (MDI) or a Nebulizer.

1.  Metered Dose Inhaler (MDI):  This is the preferred method for most asthmatics because it's easily portable and can be used anywhere.  This is also the best method to deliver medicine to children who cannot tolerate a mask or mouthpiece nebulizer.

According to NationalJewishHealth.org, using an MDI with a spacer (or spacer/mask) is just as effective as a nebulizer if proper technique is used (the only exception is with severe exacerbations).

2.  Nebulizer:  This is a device that turns a liquid form of Albuterol into a mist to inhale. A treatment usually takes several minutes to complete, but this is the easiest way of getting the medicine to anyone who has trouble with inhalers, such as young children.  It's also the preferred delivery method for some asthmatics when they are having severe trouble breathing (for example, we use this method most often in the hospital).

There are three ways to give a nebulizer:

Mouthpiece: I think this is the best delivery method for nebulized medicine because the medicine is delivered right to the lungs.  But the problem with the mouthpiece is some kids can't use it properly.

Mask: The second best method is to connect a mask to the nebulizer and strap the mask to the child's face.  The mask acts like a reservoir and stores some of the medicine as the child breathes, resulting in good medicine distribution to the lungs. The problem with the mask is that some kids don't like them.

Blowby: This is where the parent or respiratory therapist simply prepares the nebulizer so the medicine blows by the child's mouth and nose.  This method is the easiest for both child and caregiver, but studies show hardly any of the medicine actually makes it down to the lungs.  And, according to Bill Pruit's article RT Magazine, "Kids and Asthma: Making (and Teaching) the Right Choices," blowby's are "considered to be inappropriate and should not be used."

That in mind, the following are the latest recommendations by the American Association of Respiratory Care (AARC) according to Arzu Ari (PhD, PT, RRT, CPFT) in the August, 2009 issue of AARC Times, "Optimal Delivery of Aerosol Drugs in the Pediatric/Neonatal Patient Population":