Pediatric Drugs

, Volume 5, Issue 9, pp 629–638 | Cite as

Use of Inhaler Devices in Pediatric Asthma

  • Fernando Maria de BenedictisEmail author
  • David Selvaggio
Review Article


Inhalation is the preferred route for asthma therapy, since it offers a rapid onset of drug action, requires smaller doses, and reduces systemic effects compared with other routes of administration. Unfortunately, inhalation devices are frequently used in an empirical manner rather than on evidence-based awareness.

A wide variety of nebulizers are available. Conventional jet nebulizers are highly inefficient, as much of the aerosol is wasted during exhalation. However, incorporating an extra open vent into the system has considerably increased the amount of drug that patients receive. Breath-assisted open vent nebulizers limit the loss of aerosol during exhalation, but are dependent on the patient’s inspiratory flow. Ultrasonic nebulizers produce a high mass output and have a short nebulization time, but are inefficient for delivering suspensions or viscous solutions. Adaptive aerosol delivery devices release a precise dose that is tailored to the individual patient’s breathing pattern. Nebulizers have several drawbacks, and their use should be limited to patients who cannot correctly manage other devices.

Pressurized metered-dose inhalers (pMDI) are practical, cheap and multidose. However, there are several problems with their use. Breath-actuated MDI are easy to use and can be activated by very low flow. However, young children may not be able to use them efficiently. Dry powder inhalers (DPI) are portable and easy to use. They are indicated either for rescue bronchodilator therapy or for regular treatment with inhaled corticosteroids and long-acting bronchodilators. The use of spacers reduces oropharyngeal deposition and improves drug delivery to the lung. Spacers do not require patient coordination, but some general rules must be followed for their optimal use.

Thus, the choice of a delivery device mainly depends on the age of the patient, the drug to be administered and the condition to be treated. Proper education is also essential when prescribing an inhalation device.


Inspiratory Flow Drug Particle Lung Deposition Inhalation Device Mass Median Aerodynamic Diameter 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We thank Consuelo Ramacogi for secretarial assistance in the preparation of this manuscript.

The authors have provided no information on sources of funding or on conflicts of interest directly relevant to the content of this review.


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Copyright information

© Adis Data Information BV 2003

Authors and Affiliations

  • Fernando Maria de Benedictis
    • 1
    Email author
  • David Selvaggio
    • 1
  1. 1.Department of Pediatrics“Salesi” Children’s HospitalAnconaItaly

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