Pedia-Devices

A Brief History of Inhalers

The concept of inhaling therapeutic substances dates back thousands of years, with ancient civilizations in Egypt, India, and China using herbs and aromatic vapors for respiratory ailments. These early practices involved burning medicinal plants and inhaling the smoke through basic apparatus.

Modern inhaler development began during the industrial revolution in the mid-1800s. In 1778, John Mudge created one of the first documented inhalation devices using a pewter mug with a flexible tube for delivering opium vapor to treat coughs. The first dry powder inhaler was invented in 1852 by physician Ira Warren in Boston. Throughout the 1800s and early 1900s, various nebulizer devices emerged that transformed liquid medications into fine mists for inhalation.

The breakthrough moment came in 1956 when the first pressurized metered-dose inhaler was introduced, inspired by a 13-year-old girl named Susie Maison who asked her father why her asthma medicine could not be as convenient as hairspray. This innovation revolutionized respiratory care, making treatment portable and accessible to millions. Since then, inhaler technology has continued to evolve with dry powder inhalers gaining popularity in the 1970s and 1980s, followed by soft mist inhalers and smart digital devices in recent decades. According to research published in the Journal of Aerosol Medicine and Pulmonary Drug Delivery, these advances have dramatically improved drug delivery efficiency and patient outcomes.

Purpose of Inhalers

Inhalers are medical devices designed to deliver medication directly into the lungs through inhalation. This targeted delivery system offers several important advantages over oral medications.

Key Benefits of Inhaled Therapy

Delivers medication directly to affected airways
Provides faster relief compared to oral medications
Requires lower medication doses
Reduces systemic side effects
Works within minutes for quick-relief medications

Common Conditions Treated

Inhalers are primarily used to manage respiratory conditions in children, including:

Asthma: The most common reason for inhaler use in children
Reactive Airway Disease: Similar to asthma with temporary symptoms
Bronchiolitis: In some cases requiring bronchodilators
Chronic Lung Disease: Including conditions from prematurity
Cystic Fibrosis: For airway clearance and infection prevention
Exercise-Induced Bronchoconstriction: Prevention before physical activity

Where Inhalers Are Used

Inhalers can be used in various settings:

Home for daily maintenance and rescue medication
Schools for supervised medication administration
Emergency departments for acute respiratory distress
Hospitals for inpatient respiratory management
Clinics during routine checkups and sick visits
Sports venues before exercise or activities

Types of Inhalers for Children

There are three main types of inhalation devices used in pediatric care, each with specific characteristics and age-appropriate applications.

1. Metered-Dose Inhalers (MDI)

MDIs are the most commonly prescribed inhalers worldwide. They contain medication in a pressurized canister that releases a measured dose when activated.

MDI Characteristics

Small, portable, and quick to use
Requires coordination between pressing and breathing
Delivers one measured dose per actuation
Contains multiple doses in one device
Uses propellant to push medication out
Most effective with a spacer or valved holding chamber

MDI Advantages

Compact and easy to carry
Works quickly for symptom relief
Less expensive than some alternatives
Low risk of contamination
Available for most respiratory medications

MDI Challenges

Requires proper timing and coordination
May cause throat irritation without spacer
Difficult for young children without accessories
Needs priming if not used regularly

2. Dry Powder Inhalers (DPI)

DPIs deliver medication as a fine powder that is released when the child takes a deep, quick breath through the device.

DPI Characteristics

Breath-activated delivery system
No propellant required
Medication stored as powder in capsules or blisters
Requires strong, quick inhalation
Usually for children 5 years and older
Cannot be used with spacers

Common DPI Devices

Diskus (disk-shaped, multi-dose)
Turbuhaler (tube-shaped, multi-dose)
Twisthaler (twist-to-load design)
HandiHaler (single-dose capsule)
Breezhaler (capsule-based)
Flexhaler (dose indicator included)

DPI Advantages

No coordination between pressing and breathing needed
No propellant chemicals
Easier for older children to master
Often includes dose counters

DPI Challenges

Not suitable for children under 4-5 years
Requires adequate inspiratory flow
Cannot be used during severe breathing difficulty
Sensitive to moisture and humidity
Multiple steps increase chance of errors

3. Nebulizers

Nebulizers convert liquid medication into a fine mist that can be inhaled through normal breathing over several minutes.

Nebulizer Characteristics

Transforms liquid medication into aerosol mist
Requires electrical power or battery
Treatment takes 10-15 minutes
Can use mouthpiece or face mask
Suitable for all ages including infants
No special breathing technique needed

Types of Nebulizers

Jet Nebulizers: Use compressed air to create mist
Ultrasonic Nebulizers: Use sound waves for aerosolization
Mesh Nebulizers: Use vibrating mesh technology, quieter and portable

Nebulizer Advantages

Perfect for infants and young children
No special technique required
Effective during severe breathing problems
Can deliver multiple medications simultaneously
Good for children with poor coordination

Nebulizer Challenges

Time-consuming treatment
Not portable (standard models)
Requires cleaning after each use
More expensive initial cost
Needs power source
Risk of contamination if not cleaned properly

Spacers and Valved Holding Chambers

These are accessory devices that attach to MDIs to improve medication delivery and ease of use.

Why Spacers Are Important

Research shows that using a spacer with an MDI can improve drug delivery to the lungs by up to 4 times compared to using an MDI alone. Most respiratory guidelines recommend spacer use for all children using MDIs.

Spacer Features

Holds medication cloud temporarily
Eliminates need for perfect coordination
Reduces medication deposited in mouth and throat
Decreases side effects like thrush
One-way valve prevents exhaling into device
Some include whistles to indicate proper breathing speed
Available with masks for children under 4-5 years

Age Group	Recommended Device	Accessory Needed
Under 4 years	MDI or Nebulizer	Spacer with face mask
4-5 years	MDI or Nebulizer	Spacer with mouthpiece (if able)
5-12 years	MDI with spacer or DPI	Spacer for MDI
13 years and above	MDI with spacer or DPI	Spacer recommended for MDI

How to Use Inhalers: Step-by-Step Guide

Proper technique is essential for effective medication delivery. Incorrect use is common and can reduce treatment effectiveness significantly.

Using a Metered-Dose Inhaler (MDI) Without Spacer

This technique is typically suitable only for older children and teenagers who can coordinate well.

1 Prepare the Inhaler

Remove the cap. Shake the inhaler vigorously for 5 seconds. If the inhaler is new or has not been used for several days, prime it by releasing 2-4 test sprays into the air away from your face.

2 Position Correctly

Stand or sit up straight. Tilt head back slightly. Hold the inhaler upright about 1-2 inches away from your mouth, or place the mouthpiece between your teeth and close lips around it.

3 Exhale Completely

Breathe out fully through your mouth to empty your lungs. Do not breathe out into the inhaler.

4 Inhale and Activate

As you start breathing in slowly and deeply through your mouth, press down firmly on the top of the canister once. Continue breathing in slowly for 3-5 seconds.

5 Hold Breath

Remove the inhaler from your mouth. Hold your breath for 10 seconds, or as long as comfortable. This allows medication to settle in the airways.

6 Breathe Out and Wait

Breathe out slowly through your nose or mouth. If a second puff is prescribed, wait 30-60 seconds before repeating steps 2-5.

7 Rinse Mouth

If using a steroid inhaler, rinse your mouth with water and spit it out to prevent thrush. Wipe the mouthpiece and replace the cap.

Using an MDI with Spacer (Mouthpiece)

This is the recommended method for most children and provides better medication delivery.

1 Assemble Device

Remove caps from inhaler and spacer. Shake the inhaler well. Insert the inhaler mouthpiece into the back of the spacer.

2 Position and Seal

Place the spacer mouthpiece between your teeth and close lips tightly around it to create a good seal.

3 Press and Breathe

Press the inhaler canister once. Immediately begin breathing in slowly and deeply through your mouth. Take a full, deep breath.

4 Hold Breath

Hold your breath for 10 seconds if possible. Breathe out slowly through the spacer or away from it.

5 Repeat if Needed

Wait 30-60 seconds before taking another puff if prescribed. Shake the inhaler again before each additional puff.

Using an MDI with Spacer and Mask

This method is ideal for infants and children under 4-5 years who cannot use a mouthpiece effectively.

1 Set Up

Attach the mask to the spacer. Insert the inhaler into the spacer. Shake the inhaler thoroughly.

2 Position Mask

Hold the child in an upright or semi-upright position. Place the mask firmly over the child's nose and mouth, ensuring a tight seal with no gaps.

3 Administer Medication

Press the inhaler once. Keep the mask in place and allow the child to breathe normally through the mask for 6-10 breaths. Watch for the valve opening and closing with each breath, or observe chest rise and fall.

4 Complete Treatment

If multiple puffs are prescribed, remove the mask briefly, shake the inhaler, and repeat the process for each puff.

Important: Never give multiple puffs into the spacer at once. Each puff should be given separately with adequate breathing time in between.

Using a Dry Powder Inhaler (DPI)

Technique varies by device type, but general principles apply to most DPIs.

1 Prepare Device

Remove the cover. Load the dose according to device instructions (insert capsule, twist, or slide lever). Do not shake DPIs.

2 Exhale Away

Breathe out fully, away from the device. Never breathe into a DPI as moisture can clump the powder.

3 Seal and Inhale

Place the mouthpiece between teeth and seal lips tightly around it. Breathe in quickly and deeply through your mouth in one strong, steady breath.

4 Hold and Exhale

Remove the device. Hold your breath for 10 seconds. Breathe out slowly away from the device.

5 Check and Close

Check that the dose has been used (capsule empty, dose counter decreased). Close the device and replace the cap.

Using a Nebulizer

1 Prepare Solution

Wash hands thoroughly. Open medication ampules and pour prescribed amount into the nebulizer cup. Add saline if directed.

2 Assemble Equipment

Attach the nebulizer cup to the mouthpiece or mask. Connect tubing to the nebulizer and air compressor.

3 Position Patient

Have the child sit upright or in a comfortable semi-upright position. Ensure they are calm and relaxed.

4 Start Treatment

Turn on the compressor. Place the mouthpiece in the child's mouth or hold the mask firmly over nose and mouth. Encourage normal breathing through the mouth.

5 Complete Session

Continue until the medication is finished and the mist stops, usually 10-15 minutes. Occasionally tap the cup to ensure all medication is used.

6 Clean Up

Turn off the machine. Have the child rinse their mouth if using steroid medication. Disassemble and clean all parts according to manufacturer instructions.

Precautions and Safety Information

General Safety Guidelines

Critical Safety Rules

Never exceed the prescribed dose without medical advice
Seek immediate medical help if symptoms worsen despite medication
Do not share inhalers between people
Keep inhalers away from extreme heat or open flames
Monitor for signs of medication side effects

Before Using Inhalers

Inform your doctor about all medications your child takes
Tell your doctor if your child has heart problems, seizures, or diabetes
Ensure proper inhaler technique has been demonstrated
Check expiration dates before each use
Prime new inhalers as directed
Keep track of doses remaining

Possible Side Effects

Most side effects are mild and temporary. Different medications have different side effect profiles.

Quick-Relief Medications (Bronchodilators)

Rapid heartbeat or palpitations
Shakiness or tremors in hands
Nervousness or jitteriness
Headache
Dizziness
Upset stomach

Controller Medications (Corticosteroids)

Oral thrush (white patches in mouth)
Hoarse voice
Cough
Throat irritation
Rare: slowed growth (with high doses long-term)

Preventing Steroid Side Effects

Using a spacer and rinsing the mouth after each dose significantly reduces the risk of oral thrush and other local side effects. Always use the lowest effective dose as prescribed by your doctor.

When to Seek Medical Attention

Emergency Warning Signs

Call emergency services or go to the nearest hospital if your child experiences:

Severe breathing difficulty despite using quick-relief inhaler
Blue color around lips or fingernails
Inability to speak in full sentences
Chest retractions (skin pulling in around ribs)
Rapid breathing that does not improve
Extreme drowsiness or confusion
No improvement after 3 doses of rescue inhaler in one hour

Storage Precautions

Store at room temperature, away from direct sunlight
Keep MDIs away from heat sources above 49 degrees Celsius
Protect DPIs from moisture and humidity
Never puncture or incinerate pressurized canisters
Store out of reach of young children
Keep spacers clean and dry between uses

Special Precautions for Different Settings

At School

Provide written authorization from doctor
Ensure school staff knows how to help child use inhaler
Keep emergency contact information updated
Consider keeping spare inhaler at school
Inform PE teachers about exercise-induced symptoms

During Travel

Pack inhalers in carry-on luggage, never checked bags
Bring extra medication in case of delays
Carry prescription or doctor's letter for security
Be aware of temperature extremes during travel
Know location of nearest medical facilities at destination

During Exercise and Sports

Use prescribed medication 15-30 minutes before exercise if directed
Keep rescue inhaler readily accessible during activities
Warm up gradually before intense exercise
Stop activity if breathing becomes difficult
Inform coaches about asthma and medication needs

Medication Interaction Warnings

Some medications may interact with inhaled medications. Always inform healthcare providers about:

Beta-blockers (including eye drops for glaucoma)
Other respiratory medications
Heart medications
Antidepressants
Herbal supplements
Over-the-counter cold medications

Pregnancy and Breastfeeding

For teenagers who may be pregnant or breastfeeding, most inhaled asthma medications are considered safe, but they should always consult with their doctor for personalized advice. Uncontrolled asthma poses greater risks than most inhaled medications.

Frequently Asked Questions

How do I know when my inhaler is empty?

Many modern inhalers have built-in dose counters. For those without counters, track doses manually from the start. Never test by spraying into the air repeatedly, as this wastes medication. Floating test in water is unreliable and not recommended as water can damage the device. Get a refill when the counter shows 20 doses remaining.

Can my child use an inhaler during a cold or flu?

Yes. Children with asthma should continue their controller medications during illnesses. Respiratory infections often trigger asthma symptoms, so maintaining regular treatment is important. Contact your doctor if symptoms worsen or rescue medication is needed more frequently than usual.

Is it safe to use inhalers every day?

Yes, controller medications are designed for daily use and are safe when used as prescribed. These medications prevent symptoms and reduce inflammation over time. Never stop controller medications without consulting your doctor, even if your child feels well.

What is the difference between rescue and controller inhalers?

Rescue inhalers (quick-relief) contain bronchodilators that work within minutes to open airways during symptoms or before exercise. Controller inhalers contain medications like corticosteroids that reduce inflammation and prevent symptoms when used daily. Both serve different important purposes in asthma management.

My child gets thrush from the inhaler. What can I do?

Always use a spacer with steroid inhalers and rinse the mouth thoroughly with water after each use, spitting out the water. Have your child brush their teeth after using steroid inhalers. If thrush develops despite these measures, contact your doctor for treatment.

Can cold weather affect my child's inhaler?

Very cold temperatures can reduce the effectiveness of MDIs. Keep the inhaler warm, such as in an inside pocket close to the body. Allow it to warm to room temperature before use if it has been in the cold. DPIs are less affected by temperature but should still be kept at moderate temperatures.

How long does an inhaler last once opened?

This varies by medication. Most MDIs remain effective for 1-2 years from manufacture date. DPIs typically have shorter shelf lives, often 3-6 months after opening. Always check the expiration date on the device and follow manufacturer recommendations. Store properly to maintain effectiveness.

Should I wake my child at night for scheduled inhaler doses?

Most controller medications are prescribed twice daily (morning and evening) and do not require waking a sleeping child. If your doctor has prescribed specific nighttime dosing, follow their instructions. Well-controlled asthma should not require middle-of-the-night treatments.

Can my child swim or play sports while using inhalers?

Yes. With proper asthma management, children can participate fully in sports and activities. Use prescribed pre-exercise medication 15-30 minutes before activity. Swimming is often well-tolerated. Keep rescue inhaler accessible during activities and teach your child to recognize early warning signs.

What if my child refuses to use the inhaler?

Stay calm and patient. For young children, try distraction with toys, songs, or videos during treatment. Make it part of a routine. Praise cooperation. For older children, explain why the medicine is important in age-appropriate terms. Let them choose the spacer color or design. If resistance continues, discuss with your doctor about alternative delivery methods.

Are there any foods or drinks to avoid when using inhalers?

No specific foods need to be avoided. However, caffeine can increase the side effects of some bronchodilators like shakiness and rapid heartbeat. Maintain a balanced diet. For oral thrush prevention with steroid inhalers, rinse mouth after use before eating or drinking.

Will my child need inhalers forever?

This depends on the condition and its severity. Some children outgrow asthma, while others require long-term management. Many children can reduce or stop medications as they grow older with proper treatment and management. Regular follow-ups with your doctor will help determine the ongoing need for treatment.

Device Care and Maintenance

Proper cleaning and maintenance ensure your inhaler works correctly and remains hygienic.

Cleaning Metered-Dose Inhalers

1 Remove Canister

Take the metal canister out of the plastic holder. Never wash the metal canister.

2 Wash Holder

Wash the plastic holder and cap in warm running water. Use mild soap if needed. Do not use hot water.

3 Dry Completely

Shake off excess water. Allow to air dry completely overnight. Never dry with towels as lint can clog the mouthpiece.

4 Reassemble

Once completely dry, put the canister back into the holder. Test spray once before use.

Cleaning frequency: Clean MDI holders once a week, or more often if visible buildup occurs.

Cleaning Spacers and Valved Holding Chambers

1 Disassemble

Take apart all pieces of the spacer including any removable valves or backpieces.

2 Soak and Wash

Soak parts in warm water with mild dish soap for 15 minutes. Gently wash each part. Do not scrub vigorously as this creates static that attracts medication particles.

3 Rinse Thoroughly

Rinse all parts under warm running water to remove all soap residue.

4 Air Dry

Shake off excess water. Allow to air dry completely in a clean area. Do not wipe with towels.

5 Reassemble When Dry

Put all parts back together. Prime the spacer by spraying one puff into it before the first use after cleaning.

Cleaning frequency: Clean spacers at least once a week, or according to manufacturer instructions.

Cleaning Dry Powder Inhalers

Most DPIs should never be washed with water. Follow manufacturer-specific instructions.

1 Wipe Mouthpiece

Use a clean, dry cloth or tissue to wipe the mouthpiece after each use.

2 Weekly Cleaning

Once a week, use a dry brush or clean, dry cloth to remove any powder buildup from the mouthpiece.

3 Inspect Regularly

Check for blockages or damage. Never blow into the device to clean it.

Important: Never wash DPIs with water unless specifically instructed by the manufacturer. Moisture damages the dry powder medication.

Cleaning Nebulizers

Nebulizers require thorough cleaning after each use to prevent contamination and infection.

After Each Use

1 Disassemble

Take apart the nebulizer cup, mouthpiece or mask, and tubing connector. Do not wash the tubing or compressor.

2 Rinse

Rinse all parts (except tubing) with warm running water. Shake off excess water.

3 Air Dry

Allow parts to air dry on a clean paper towel in a clean area away from the kitchen.

Deep Cleaning (Daily or Every Other Day)

1 Wash with Soap

Wash all parts with warm water and mild dish soap. Use a soft brush if needed.

2 Disinfect

Soak parts in one part white vinegar to three parts water for 30 minutes, or use manufacturer-recommended disinfectant solution.

3 Final Rinse

Rinse thoroughly with sterile or distilled water (not tap water). Shake off excess.

4 Dry and Store

Air dry completely on clean paper towels. Store in a clean plastic bag or container once fully dry.

Compressor Maintenance

Wipe the outside with a damp cloth weekly
Check air filter monthly; replace if dirty or discolored
Never submerge the compressor in water
Inspect tubing for cracks or moisture; replace if damaged

General Maintenance Tips

Device Part	Cleaning Method	Frequency	Warning
MDI Holder	Warm water rinse	Weekly	Remove canister first
Spacer	Soap and water soak	Weekly	Do not scrub vigorously
DPI	Dry wipe only	After each use	Never use water
Nebulizer Parts	Rinse and disinfect	After each use	Air dry completely
Face Masks	Soap and water	After each use	Replace if cracked

When to Replace Device Parts

Spacers: Replace every 6-12 months or if damaged, cracked, or valve is not working
Nebulizer parts: Replace every 3-6 months or according to manufacturer guidelines
Masks: Replace when no longer fitting properly or if damaged
Tubing: Replace if cracked, yellowed, or has moisture inside
DPI devices: Dispose of when empty as per instructions

Signs Your Device Needs Replacement

Cracks or damage to any part
Valve not opening or closing properly
Mouthpiece blocked or clogged
Device no longer delivers medication effectively
Spacer has visible buildup that will not clean off
Discoloration or bad odor despite cleaning

Available Brands and Types

Many different inhaler brands are available worldwide. The choice depends on the medication prescribed, age of the child, and local availability.

Common Quick-Relief (Rescue) Inhalers

Common Controller (Maintenance) Inhalers

Spacer and Holding Chamber Brands

Nebulizer Machine Brands

Cost Considerations

Inhaler costs vary significantly by country, insurance coverage, and whether generic versions are available. Here are general price ranges:

Approximate Cost Ranges (Without Insurance)

Note: Prices vary widely by region and availability. These are rough estimates for reference only.

Generic Albuterol MDI: Ranges from moderate to affordable in most countries
Brand-name rescue inhalers: Generally more expensive than generics
Controller inhalers: Typically higher cost, varies by medication type
Spacers: Usually affordable, ranging from basic to premium models
Nebulizers: One-time investment, jet nebulizers more affordable than mesh types

Cost-Saving Tips

Ask your doctor if generic versions are available
Check if patient assistance programs exist in your area
Some manufacturers offer coupon programs or discount cards
Compare prices at different pharmacies
Check if your insurance has preferred brands with lower copays
Some charitable organizations provide free or low-cost inhalers
Government health programs may cover costs for eligible families

Important: Never compromise on prescribed medication due to cost. Speak with your doctor or pharmacist about affordable alternatives. Many regions have programs to help families access necessary asthma medications.

Choosing the Right Device

Your healthcare provider will recommend the most appropriate device based on:

Child's age and ability to coordinate breathing
Specific medication being prescribed
Frequency of medication needs
Severity of respiratory condition
Lifestyle and portability needs
Cost and insurance coverage
Personal preference and comfort

Additional Tips for Success

Teaching Children Proper Technique

Demonstrate the technique yourself first
Practice with the device when the child is not having symptoms
Use visual aids or videos to show proper technique
Praise and encourage the child during practice
Make it a regular part of daily routine
For young children, use games or songs to make it fun
Involve the child in choosing spacer colors or designs
Regularly review technique with your healthcare provider

Keeping Track of Medications

Keep a medication diary or use smartphone apps
Set daily alarms for scheduled doses
Track how often rescue inhaler is needed
Note when symptoms occur and possible triggers
Record when inhalers are refilled
Share medication records with all caregivers
Bring medication list to all medical appointments

Creating an Asthma Action Plan

Work with your doctor to create a written plan that includes:

Daily controller medications and doses
When to use quick-relief medication
How to recognize worsening symptoms
Emergency contact information
When to seek medical care
Known triggers to avoid

Good Asthma Control Indicators

Your child's asthma is well-controlled if:

Daytime symptoms occur 2 or fewer days per week
No nighttime awakenings due to asthma
Rescue inhaler needed 2 or fewer days per week
No limitations on normal activities
Lung function remains normal

Resources for Further Information

For more detailed information about inhalers and respiratory health in children, consult these reliable resources:

Recommended Medical References

Global Initiative for Asthma (GINA) Guidelines
National Asthma Education and Prevention Program (NAEPP)
British Thoracic Society Guidelines
American Academy of Pediatrics respiratory health resources
World Health Organization respiratory disease information

Professional Organizations Websites

American Lung Association
Asthma and Allergy Foundation of America
European Respiratory Society
Allergy and Asthma Network
Your national or regional respiratory health organization

Always consult with your healthcare provider for personalized medical advice regarding your child's specific condition and treatment needs.

Medical Device Guides

Complete Guide to Inhalers for Children: Types, Usage & Safety Tips

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