Write a short note on Inhalation Devices in Children.

Principle

• The inhaled route is preferred for asthma drugs because it delivers the drug directly to the airways, achieving a rapid effect with a small dose and fewer systemic side-effects.
• Choosing the right device for the child's age and ensuring correct technique are as important as the drug itself.

Types of Devices

• Metered-Dose Inhaler (MDI) — delivers a fixed dose; requires good hand–breath coordination, so it is not ideal alone for young children.
• MDI + Spacer — the device of choice in children; the spacer removes the need for coordination and improves lung deposition. Use with a face mask < 4 years and a mouthpiece in older children.
• Nebuliser — converts liquid drug to a fine mist; useful in acute severe attacks and in very young/uncooperative children.
• Dry-Powder Inhaler (DPI) — breath-actuated; suitable for older children (> 6–8 years) who can generate a strong, fast inspiration.

Device Selection BY Age

Key Points on Technique

• Shake the MDI, actuate one puff at a time into the spacer, and take several tidal breaths (or a slow deep breath).
• Rinse the mouth after inhaled steroids (prevents oral thrush).
• Check inhaler technique at every visit — poor technique is a common cause of 'treatment failure'.

Advantages of the Inhaled Route

• Drug delivered directly to the target (airways) → rapid onset.
• A much smaller dose is needed → fewer systemic side-effects than oral/IV drugs.

Common Pitfalls

• Poor coordination with an MDI alone; not using a spacer in young children.
• Not rinsing the mouth after inhaled steroids (oral thrush); using an out-of-date/empty canister.

Choosing & Teaching the Device

• Match the device to the child's age and ability; demonstrate and have the caregiver demonstrate back.
• Re-check technique at follow-up; provide written/pictorial instructions.
• Ensure the spacer is cleaned correctly and the canister is not empty.

Spacer with mask under 5 years; mouthpiece thereafter.