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The use of inhaler devices in children

Robert H Moore, MD
Section Editors
Gregory Redding, MD
Robert A Wood, MD
Deputy Editor
Elizabeth TePas, MD, MS


The pressurized metered dose inhaler (pMDI) has been a mainstay in the treatment of respiratory diseases, especially asthma, since its introduction in 1956. It is the most commonly prescribed delivery system for administering inhaled bronchodilators and anti-inflammatory agents worldwide [1,2]. Spacer devices, when used properly, substantially improve the delivery of pMDI-generated aerosols to the distal airways. The pMDI, used alone or in combination with a spacer or valved-holding chamber, is the most convenient and cost-effective way to administer aerosolized medications for most patients.

Dry powder inhalers (DPIs) are a separate group of medication aerosolizing devices widely used in the management of adult and pediatric pulmonary disease. These devices eliminate the need for propellants and are less dependent upon coordination of inhalation and device actuation. Short- and long-acting beta agonists and inhaled glucocorticoids are available for administration via DPIs.

The effectiveness of both delivery systems is dependent upon several factors, including the properties of the agent administered, design, temperature, humidity, and patient technique [3,4]. Device technique should be assessed during every encounter to ensure optimal use and drug delivery to the lungs. The use of pMDIs and DPIs in children is discussed here. Other aspects of aerosol therapy, including the use of nebulizers, are presented separately. (See "Delivery of inhaled medication in children" and "Use of medication nebulizers in children".)


A pressurized metered dose inhaler (pMDI) contains drug, which usually is either crystallized or in solution, along with the propellant and a surfactant (picture 1) [2].

Propellants — The most common type of propellants used are the hydrofluoroalkanes (HFA). In some cases (such as with HFA beclomethasone), the use of HFA has increased the output of respirable particles [5,6], improved the delivery of drug to the lower airways, and decreased deposition in the oropharynx compared with previously used propellants [7]. Improved delivery to peripheral airways may necessitate the reduction of drug dose, particularly when using an inhaled glucocorticoid [8]. (See 'Spacer devices' below.)

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Literature review current through: Nov 2017. | This topic last updated: Sep 08, 2017.
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