Q: My child was just diagnosed with asthma. What do I need to know about inhalers?

Ask Our Expert about Asthma Inhalers

About Our Expert

Robert Miller, M.D., is a board-certified and fellowship-trained pediatric pulmonologist. He and his team of nurse practitioners, nurses, respiratory therapists and others have helped children overcome breathing problems for more than 25 years. He is a past winner of the Faculty Teaching Award from the State University of New York Health Science Center, the Golden Apple Award from the Children's Hospital National Medical Center, the Pediatric Fellowship Award from the American Lung Association Affiliates of the National Capitol Area, and the Internship Teaching Award from the State University of New York Health Science Center.

Among Dr. Miller's colleagues are Cynthia Schmoyer and Eleanor Peluso, respiratory therapists for Lehigh Valley Hospital and Health Network's Pediatric Specialty Center. Also certified asthma educators, they help educate children about proper inhaler use and contributed to this article.

• My child was just diagnosed with asthma. What do I need to know about inhalers?
• How will my child know when he's running low on medicine?
• Is it true that some inhalers contain dangerous chemicals to "push" the medicine out?
• The doctor recommended a spacer. What is it and how is it used?
• How do we prevent asthma attacks from occurring?
• What do we do if we're without medication and my child has an attack?

Q: My child was just diagnosed with asthma. What do I need to know about inhalers?

A: Treating asthma today is much different than it was even just a few years ago. Newer inhaler options give better flexibility in how the medicine is delivered and the type of medicines you can use.

There are three main types of inhalers: metered dose, dry powdered and nebulizers. The metered-dose and dry-powdered inhalers are handheld devices that deliver a precise dose of asthma medication into the lungs. The nebulizer is a portable mechanical device that uses liquid medication that turns into a mist. It's important to talk with your child's doctor about which inhaler would best suit his needs and which type you are most comfortable using.

The metered-dose inhaler consists of a pre-filled pressurized canister that holds the medicine, a mouthpiece and a pump. You or your child is responsible for spraying the medicine while your child is inhaling.

With the dry-powder inhaler, you are responsible for putting the medicine (often in capsule or cartridge form) into the inhaler. You do not have to pump the inhaler; instead, the medicine will be automatically activated once your child inhales.

With the nebulizer, you are responsible for putting a measured dose of medication (called Albuterol) into a canister. The canister is then connected to the machine by a tube. An on-off switch activates the machine; your child begins inhaling when the machine is turned on and continues until all the medication is evaporated.

Q: How will my child know when he's running low on medicine?

A: Some metered-dose inhalers now include counters that let you know how many doses remain. If you have a metered-dose inhaler without a counter, you can still monitor the dosage by doing some simple math. The label on the inhaler's canister lists the total number of doses contained within. It's up to you to count them. Some tips: marking the canister with lines or tape after each dose, or recording it on a calendar that's in the room where your child gets his medication.

This is not an issue with dry-powdered inhalers or nebulizers. Because you are putting medicine into these inhalers at each dose, you will always know how much remains.

No matter which type of inhaler you use, planning for emergencies is important. For example, if you're going on vacation, it's wise to bring an extra cartridge or canister just in case.

Q: Is it true that some inhalers contain dangerous chemicals to "push" the medicine out?

A: Traditionally, chlorofluorocarbons (CFC) have been used to propel the drug into the lungs, and was the industry standard for a long time. But in the late 1990s, hydrofluoroalkane (HFA) started to replace CFC inside inhalers because of concerns for the environment. HFA will become the U.S. Food and Drug Administration's standard in 2009.

Both chemicals offer the same amount of safety and consistency for the user, although the taste and feel is different in HFA inhalers than in CFC inhalers. If you still have an inhaler that uses CFCs, contact your doctor about making the switch, because CFC inhalers have already begun to be phased out.

Q: The doctor recommended a spacer. What is it and how is it used?

A: Also called holding chambers, spacers are used to help deliver the medicine more effectively into the lungs. Without a spacer the medicine will often coat the mouth and throat but not the lungs, where it is needed. However, the spacer is needed only if you have a metered-dose inhaler.

The spacer attaches to the inhaler and holds the "puff" between you and the device, allowing you to inhale the medicine slowly and more completely. Both children and adults should use the spacer whenever required.

Q: How do we prevent asthma attacks from occurring?

A: The best way to prevent attacks is to have an "asthma action plan" to be proactive and prevent attacks from occurring. The plan allows you to adjust your child's medication amounts depending on the severity of the child's symptoms. For instance, if your child has a cough, cold or wheeze, you can up their medication strength and vice versa. There are also medications that offer a "rescue" by relaxing the airway, allowing your child to breathe normally.

Q: What do we do if we're without medication and my child has an attack?

A: Call 9-1-1 immediately and get your child to the nearest emergency room.

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