Inhalers for asthma

Most families in the Emergency Department will talk about their child’s “blue” and “brown” inhaler. Can we, or they, tell which is the reliever and which the preventer?

Click here for a printable table of some common inhalers listed by colour. I have also found a very useful site put together by a pharmacist and a medical student with photos of lots of the inhalers so you can get your patient to identify which one they are on. Take a look at http://www.rch.org.au/clinicalguide/asthmadevices/

*Device*	*Comments*
Standard metered dose inhaler (MDI)	Children < 12 years old unlikely to be able to use it properly without a spacer Small, conveniently pocket-sized Requires shaking and priming Not affected by humidity
MDI and spacer	Bulky Better delivery of drug at all ages NICE suggests < 5 years, all inhalers should be given with a spacer device and 5-15 years, at least the corticosteroids should be given with a spacer
Dry powder device	Children < 6 years old generally can not use it as it requires a fast, deep breath to activate it Medicine can be blown away if child accidentally breathes out Clearer when the medicine is running out than the MDI Single dose models require loading of capsules for each use Powder sticks together if high humidity

http://www.asthma.org.uk/health_professionals/materials_to_help_you_your_patients/index.html has a link to a comprehensive information leaflet for young people over the age of 12 who need to take control of their asthma management and understand their condition.

http://www.nice.org.uk/nicemedia/live/11400/32073/32073.pdf is the 2000 guideline on asthma management in the < 5 year olds

http://www.nice.org.uk/guidance/index.jsp?action=byID&r=true&o=11450 is the 2002 guideline for 5-15 year olds

Paediatric Pearls

by Dr Julia Thomson, Paediatrician

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