Childhood asthma continues to be a growing problem in the U.S. According to the CDC (Centers for Disease Control), 7.1 million U.S. children have asthma—that’s 9.5% of all children in the U.S. With the rising numbers of children diagnosed with asthma each year, it is imperative that parents and caregivers learn the proper techniques of using metered-dose inhalers and spacers with children.

What is a Metered-Dose Inhaler?
A metered-dose inhaler is a device used to deliver a specific amount of aerosolized medication to the lungs. The medication comes out as a mist or spray and is inhaled directly into the airways of the lungs. This type of inhaler is one of the most common types of inhalers used to administer asthma medications.

A specific type of inhaler, called a “rescue inhaler,” contains quick-acting (short-acting) bronchodilators, such as albuterol, to help stop an asthma attack; opening narrowed airways. Rescue medications typically last from 2-4 hours. Rescue inhalers are one of the most important tools asthma patients have to manage worsening asthma symptoms when they first begin. This type of inhaler is used by both children and adults.

Recent Study of Caregivers and Children’s Inhaler Techniques
A recent study, conducted by the Albert Einstein College of Medicine in New York City, found that most parents and caregivers do not know the proper 10-step technique to administer asthma inhaler medication to children. The study looked at a total of 169 New York City families, all having children between the ages of 2 and 9 who had persistent asthma and an asthma flare that involved hospitalization or a trip to the emergency room the previous year. Three quarters of the families were Hispanic and 23% were black. Mothers answered the most of the survey questions and the average age of the caregivers was 32. Parents were asked to demonstrate how they administered asthma medication using a stuffed toy.

Out of 169 caregivers in the study, only one knew all 10 steps, while only six parents/caregivers were able to do the five essential steps determined by the researchers. According to Dr. Marina Reznik, the study author, they were unable to determine why parents and caregivers were not able to properly administer inhaler medication to their children. Reasons may include lack training from doctors and healthcare providers.

Importance of Proper Inhaler Techniques
When inhalers are not used in the correct way, it can mean a child doesn’t receive the right amount of medication. This can then lead to worsening asthma symptoms.

Ten Steps for Children’s Proper Inhaler Technique
These are the steps that are important for administering metered dose inhaler asthma medications to children.

For Children 6 years or Older (Using only a spacer):
1) Remove the inhaler’s cap.
2) Place inhaler mouthpiece into rear opening of spacer.
3) Shake the inhaler in order to mix the medication.
4) Have your child gently breathe out.
5) Place spacer mouthpiece into your child’s mouth, with lips sealed around the spacer mouthpiece).
6) Push down on the top of the inhaler to spray medication.
7) Have your child inhale deeply and slowly (most spacers make a whistling noise if inhaling too fast).
8) Have your child hold his/her breath for a count of 10 (approximately 10 seconds).
9) Instruct your child to slowly exhale.
10) If additional medication is needed, repeat steps 3-9; but first, wait at least 30 seconds in between doses of medication. This gives the first dose of medication time to work open narrowed airways, making it easier for a second dose to work properly.

For Children Younger than 6 and/or Using a Mask with the Spacer:
1) Remove inhaler cap.
2) Place inhaler mouthpiece into rear of spacer.
3) Shake inhaler to mix asthma medication.
4) Have your child breathe out.
5) Place spacer’s mask over your child’s face, being sure to form a seal over his/her mouth and nose.
6) Push down on the top of the inhaler to spray medication.
7) Have your child inhale deeply and slowly (most spacers make a whistling noise if inhaling too fast).
8) Have your child hold his/her breath for a count of 10 (approximately 10 seconds).
9) Instruct your child to slowly exhale.
10) If additional medication is needed, repeat steps 3-9; but first, wait at least 30 seconds in between doses of medication. This gives the first dose of medication time to work open narrowed airways, making it easier for a second dose to work properly.

As childhood asthma rates continue to increase, parents and caregivers need to be sure they understand the proper techniques for giving their children metered-dose inhaler medications. The proper use of your child’s inhaler could mean the difference between controlled, stable asthma, and sick days off school and possibly life-threatening asthma attacks.

Science Daily reference article about the study: https://www.sciencedaily.com/releases/2013/10/131024182429.htm

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