Inhaler use in children with asthma.

1. Coordination difficulties, stop of inhalation at actuation and fast inhalations are the most important problems children experience when using a PA while difficulties with correct loading and splitting of the capsule are the most prevalent problems with the RO. 2. Most children older than 5 years can be taught effective use of an inhaler and once the correct technique has been learned is it rarely forgotten if the inhaler is used regularly. 3. Insufficient instruction at the time of prescription is the major cause of inefficient inhaler use in children who use their inhalers regularly. 4. Use of a TS makes it easier for children to inhale slowly. Furthermore, compared with a PA and TS reduces the occurrence of coordination problems and stop of inhalation when the aerosol is fired; otherwise there seems to be little clinical difference between a PA and a TS. 5. Problems with correct inhaler use are accentuated during episodes of acute wheeze when supervision or help from an adult may be needed. 6. Pauses between doses of inhaled bronchodilators are likely to improve bronchodilation during episodes of acute wheeze, whereas there is no need to recommend pauses between the puffs of bronchodilators or between puffs of bronchodilators and corticosteroids in the routine day to day management of patients. 7. Children using a TS should be taught to inhale as slowly as possible. Tilting the head back during inhalation, breath-holding after the inhalation and exhalation through the nose do not enhance response. Furthermore, the lung volume at which the aerosol is actuated is relatively unimportant as long as the child inhales as deeply as possible after actuating the aerosol. 8. The effect of powder inhalers is dependent upon a certain inspiratory flow rate and therefore there is a risk of reduced effect during episodes of acute wheeze or in children with low pulmonary function. This risk may be greater with a RO than with a FPI. 9. Children using a Rotahaler or a Fenoterol powder inhaler should be taught to inhale as fast as possible. They need not tilt the head backwards during inhalation or hold their breath afterwards. 10. Conclusions from one inhaler should be applied with caution to other inhalers. 11. The long list of instructions currently considered to represent the essentials of correct inhalation technique can be markedly simplified without any significant loss of effect in children receiving inhaled therapy with bronchodilators and corticosteroids.(ABSTRACT TRUNCATED AT 400 WORDS)