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Administering Inhaled Medications

Inhaled medicines are one of the great medical advances of the twentieth century. Because the medicine goes almost directly to the places where it’s needed, your child can get a much smaller total dose than if s/he had to swallow the medicine. This reduces side effects. Unfortunately, inhaled medicines can be a challenge to use, especially for younger children. In this article, we’ll tell you about the most common devices that children can use to take inhaled medications.

Inhaled Medications

The targets for most inhaled medications are either the lungs (for asthma and some flu medicines) or the tissues lining the nose (for allergy medicines). Within a few years, there may be inhaled medicines for other conditions, such as diabetes, but the goal will still be to get the medicine where it needs to go, and prevent it from going elsewhere.

Regardless of the kind of medicine, there are some basic steps to follow. All inhaled medicines have some kind of dispenser, adaptor, or nozzle that comes into direct contact with your child’s face, nose, or mouth. That means that it’s important to keep the device clean. Please read the manufacturers’ instructions and follow them carefully. Most of the devices can stand being washed in warm soapy water and then rinsed thoroughly. Some re-usable devices (NOT the canisters of medicine themselves) can be briefly boiled to sterilize them. Please be sure to give the devices time to dry between uses. That means that you might want to have two sets of devices, so that each one has plenty of time to dry completely. This is important to prevent mold and mildew from growing in them. Please NEVER put any of these devices or their parts in the microwave – that will damage them and can make them dangerously hot.

Nasal inhalers

The medicines in all nasal inhalers are designed to be absorbed in the tissues of the nose itself. These
inhalers produce fairly large droplets so that they will settle right there in the nose, and reduce the amount of medicine that goes on to the back of the throat or the lungs. For this reason, it’s important to have your child breathe in slowly and steadily – a sudden sharp breath will send the medicine down the throat or into the lungs, where it will be wasted.

Most of the medicines contain tiny particles in liquid. These particles will settle to the bottom of the container when it is not in use, so it is important to shake the container a few times before each spray. Nasal dispensers come in several forms. Some are simple squeeze bottles – to activate the spray you just squeeze the sides of the bottle. Most prescription nasal sprays come in a “spray pump” form, such as that shown in this picture (the protective cover that goes over the tip is not shown). To activate the spray, place your thumb over the bottom of the bottle with your index and middle finger on either side of the squeeze cap. When ready to give the spray, squeeze down firmly on the cap. You’ll need to do this yourself for children under the age of about 8 years – it’s too hard for younger children to coordinate.

  1. Take off the protective cap and put it somewhere that you can find it. Make sure the cap is safe from babies and toddlers – it can be a choking hazard.
  2. Shake the bottle well
  3. Have your child put the tip of the inhaler into one nostril, and hold the other nostril gently closed with a finger (you may need to help younger children with this)
  4. Have your child activate the spray while taking a steady breath in through the nose. This should be a strong but steady breath, not a sudden inhalation.
  5. For younger children this can be a cooperative project – let the child position the spray bottle and tip, and you give the actual squeeze. It can help to do it on the count of “three.”
  6. Repeat as instructed in the other nostril.
  7. Don’t forget to rinse the tip, dry it off, and replace the protective cap.

Metered Dose Inhalers

Metered dose inhalers (MDI’s) are often just called “inhalers.” The medicine inside the MDI is designed to go all the way to the lungs, so the device produces very tiny droplets. They are so tiny that most of them go right past the membranes of the mouth and throat, and end up where they are needed, in the lungs. Even so, some of the dose is likely to stick to the first surface it encounters. Since the drug is absorbed by mucous membranes, the child gets side effects, but no benefit, from any of the dose that lands on his or her mouth or throat. For this reason, experts recommend that everyone, not just children, use a chamber, or spacer, along with the MDI. At top right is a picture of a chamber with a mask, and at bottom right is a picture of a chamber with a mouthpiece. Children under the age of about 8 years do better with a mask than with a mouthpiece. Older children can use either the mask or the mouthpiece. The chamber walls catch the bigger droplets of medication that would otherwise wind up in the mouth or throat.

This helps reduce side effects. The other big advantage of chambers is that they separate the action of squeezing the inhaler from inhaling the dose. This makes it much easier for young children to coordinate. Your child over 8 years of age may want to give his or her own doses, and should always have the MDI and chamber with him or her. A fanny pack just for these items is often a good idea. If your insurance will allow it, you might ask your doctor to have your first MDI prescription be written to dispense 2 canisters. That way, when the first one runs out you won’t be caught short. If you get a refill as soon as you start the second canister, you’ll never run out. If that won’t work, then mark your calendar for a day to get the medicine refilled that is a few days before it will run out. Canisters usually hold 80 doses, so for example, if you are using two puffs, three times daily, which is 6 puffs a day, you can expect to run out in about 2 weeks of steady use.

To use the MDI:

  1. Remove the protective cap and put it where you’ll find it after use
  2. Place the mouthpiece of the MDI into the opening of the chamber or spacer
  3. If using a mask, be sure it is firmly attached at the other end of the chamber
  4. Put the mask gently but firmly on your child’s face, or have your child put the mouthpiece of the chamber in his or her mouth
  5. Squeeze the canister into the MDI to get one spray into the chamber
  6. Have your child inhale slowly and steadily – the spray can remain in the chamber for up to 30 seconds, so don’t rush the process.
  7. Have the child breathe normally through the chamber for a few more breaths. This will help ensure that s/he gets all the medicine.
  8. Repeat steps 4 – 7 as directed by your doctor.
  9. Wash all the parts in warm soapy water and let them dry.

 

Nebulizer Machines

A different way to give inhaled medication for lung conditions is through a nebulizer machine. The advantage of a nebulizer over an MDI is that you can place it on a sleeping child, and it doesn’t require much cooperation from the child. The disadvantage is that nebulizers usually take about 15 minutes for a treatment, whereas MDI’s can be done in less than one minute. The MDI is more easily portable than a nebulizer machine. Please discuss your preferences with your doctor – there may not be much difference in the effectiveness of the medicine in either case, if you use the device correctly.

Nebulizers, like MDI’s, break liquid medicine into tiny droplets that your child can breathe into his or her lungs. A nebulizer machine is a small air compressor that blows air under pressure into a flexible tubing. At the end of the tubing is a chamber that holds the medicine.

Your doctor will give you a prescription for the medication s/he wants you to use in the nebulizer. These medications usually come dispensed as single-dose vials (top right) or ampules (bottom right). You just pour the contents of one vial, or squeeze the contents of one ampule, into the medicine chamber. Be sure the machine isn’t running when you do this, or you’ll spray medicine everywhere! After you put the
medicine into the chamber, close the top of the chamber securely, then attach either a mask or a mouthpiece.
Children over the age of about 8 years can use a mouthpiece to breathe through. Children younger than 8 years old usually do better if they wear a mask. That way they don’t have to hold the mouthpiece. A mask attached to the medication chamber and tubing is shown at the left.

When they first use it, very young children and infants can feel as if a mask is smothering them, and they may struggle hard to get out of it. The hissing of the mist coming out can also frighten very young children. If your child or infant seems frightened or struggles, just hold the mask gently an inch or two in front of the child’s face until s/he gets used to the mist. Most young children can rapidly get used to the mask.

 

To Use A Nebulizer

  1. Connect the compressor to a power outlet, and then connect the flexible tubing to the compressor.
  2. Open the top of the medicine chamber and pour in the contents of one vial or ampule of medicine. Please be sure to throw them away afterwards – they are choking hazards.
  3. Securely replace the top of the chamber.
  4. Attach the mask or mouthpiece
  5. Turn on the compressor and be sure a steady fine mist is coming out of it.
  6. Most children do better if they hold the nebulizer themselves – this lets them feel in control. The first few times you use a nebulizer with a very young child, you may want to hold it yourself until the child gets used to the sight, sound, and smells of the device.
  7. If using a mask, place the elastic band behind the child’s head to hold the mask in place. If the child is sleeping, you can often just place the mask gently over the face without using the band.
  8. If using a mouthpiece, be sure the child has closed his or her mouth around it to get all the medication – and of course make sure s/he understands to breathe through the mouth, not the nose.
  9. The nebulizer only works correctly if the chamber is upright – if it tips over too far, the liquid can spill out and the nebulizer will stop making mist.
  10. When the mist stops (usually in about 10 – 15 minutes), give the chamber a little shake to be sure the medicine is all gone. When it is, take the mask off the child’s face or the mouthpiece out of the mouth, and turn off the machine. Please never leave a mask on the child’s face without the machine running.
  11.  Unplug the machine and then disconnect and wash all the re-usable parts, and let them dry.
  12. You may want to ask your doctor for a second set of tubing, chamber, and mask, so that one set can be drying thoroughly while you use the other. This will help prevent mold and mildew from growing in them.

 

Inhaled Flu Medications

At least one inhaled flu medication is now available. It is approved for use only in older children and adults. This medicine is provided as a fine powder in small blister packs.  The picture at top right shows the blister packs in the jar at far right, the inhaler in the center, and the protective cap at the right.

Each time you use the inhaler, you’ll put one of the sealed packs into a chamber on the inhaler. When you close the lid of the inhaler (lower right), a tiny pin will
break the pack and release the powder into the chamber. Your child can then place his or her mouth on the mouthpiece and inhale the fine powder directly into the lungs, as demonstrated by the adult in the photo below. Some of the older asthma medications also use similar kinds of inhalers. Your doctor will give you specific instructions for each of these inhalers.