Asthma - What use a nebulizer ?

Male: Many Pediatricians give these kids a nebulizer. Why?

Dr. Marcus: Nebulizer is a device which allows the medication to go from a liquid form into an inhaler or in this form thereby allowing the child to breathe the medication in. In certain conditions, which result in wheezing, these inhaled medications actually help relieve the spasm in the lungs to improve the breathing, decrease the wheezing and help the children breathe more easily.

Male: General rule, kids under six months don?t do as well with medicalization. Kids over six months, is that true?

Dr. Marcus: That is correct. What we have learned is that there are a group of children who wheeze, who do not respond nearly so well to the nebulizer medication and six months is a very common catalog for that. So under six months, we only give nebulizer medication if we have tested around the child and we see that they are a responder to that medication.

Male: Years ago, doctors used to give kids a wheeze, epinephrine or adrenaline shots. Is there any place for that anymore?

Dr. Marcus: We generally do not use epinephrine or adrenaline shots at this point. What we have learned is that the inhaled medications work just as well as the effects/as the shot of adrenalin and it is a lot less difficult for the child to receive.

Male: We know that some kids carry inhalers. What group of kids would be more likely that he would use an inhaler over an adult, an older kid, or certain type of kid, what would that be?

Dr. Marcus: An inhaler is a device that administers medications into the lungs in the same way that the nebulizer administers medications in a way it allows it to go into the lungs more easily. The choice of using a nebulizer versus an inhaler depends upon the child, their age and their ability to do the medication administration properly. The metered dose inhalers and dry powder inhalers that we presently have require a certain amount of skill and practice for the child to perfect in order for the medication to reach the lungs in an effective manner. We generally use spacers attached to some of these device to help this technique, again to allow the medication to be inhaled properly. What we do is we look at the child?s age, we see if he is able to take these inhalers in a proper fashion and if in fact they can, then we present it as an option. The advantage of the inhaler is two-fold. One, it is small, able to be placed in a pocket or a briefcase and therefore can go with the child where ever they are, allowing to have this medication in a very simple fashion. The other is that the inhaler takes far less time than the nebulizer. In a matter of seconds they can have their medication in their lungs where as the nebulizer may take anywhere from five to ten minutes depending upon the specific device.

Male: If a kid used an inhaler, what group or age that you would probably consider that over a nebulizer.

Dr. Marcus: There are some children as young as seven and eight years old who can use an inhaler properly and I have seen 12 and 13 year olds who were still not using it right and are still better off using the nebulizer. The nebulizer gives the medicine an easier and more reliable fashion. It only has the inconvenience of taking longer to administer and bring require to have the machine with you if you need it on the road.

Male: If you have an inhaler and they shake it and hear some noise and seemed to some way, could this ? medicine is still inside?

Dr. Marcus: It is tricky there are some inhalers where we can judge if the medication is there just by the way it feels. There are others where it is not. You need to take a look at the specific instructions of the device. Each device has its own technique for telling whether you have any medication left or not. The rule of thumb is if there is any doubt, get a new device. Each device should last for up to a month. If you have been using your device for more than a month you probably are going to need a new one.

Male: The Proventil Albuterol inhaler was commonly used one. It says 200 metered doses so you probably should keep track on how many times you used this. Is that correct?

Dr. Marcus: Ideally, if you can keep count, it will be quite helpful, 200 doses of the medication in the old Albuterol is something that we understand to be administered. However, keeping count of 200 doses over the course of the month can sometimes be difficult. The other thing to realize is that every time you use a test dose or a primary dose, it counts. And so, what we generally say is that if you are using a device for more than approximately a month and you are using it regularly during that month, you are at the point where you are ready to get a new device.