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How to Administer your Child’s Inhaled Medication(s)
Spacer with Mask
Note: In the CHEO BPD Web Site, an AeroChamber® with mask has been illustrated, and instructions for its use are provided below. This is not intended to imply that CHEO endorses the AeroChamber® over other spacers that come with a mask. Other spacers with mask may be available in your area. In general, most spacers are similarly effective.
The Spacer with Mask
The AeroChamber® is a holding device which helps to deliver medication in young children (usually under 5 years of age) who cannot coordinate their breathing well enough to use a metered dose inhaler (MDI) alone. The AeroChamber® is used together with an MDI. There are two sizes of AeroChamber® with mask. The orange AeroChamber® is used for infants less than 6 months of age. The yellow AeroChamber® is used in children approximately 6 months to 4 years of age.
Instructions
- Prepare the MDI by removing the cap, shaking the canister well, and placing it upright in the rubber opening of the AeroChamber®.
- Place the mask of the AeroChamber® over your child's face firmly, making a good seal over the nose and mouth.
- Press down on the canister, releasing one puff of medication into the AeroChamber®.
- Hold the mask in place until your child has taken at least 6 breaths. In a clear AeroChamber®, you can watch the gray valve move inside the AeroChamber® to help you count the breaths.
- If your child requires more than one puff of medication, wait at least 30 seconds, then repeat steps 1 to 4. Remember to shake the canister well before giving another puff. Do not spray more than one puff at a time into the AeroChamber®.
Hints
- If your child struggles when using this device, try to persist as most children will eventually get used to it. Your child will get medication into the lungs even if he/she cries.
- At about 4 to 5 years of age your child should be switched to a spacer with mouthpiece as this will prevent loss of medication in the nose.
- If your child is using inhaled steroids, have your child drink or rinse his/her mouth with water if able after each use. This will reduce the risk of developing a yeast infection in the mouth or throat.
- The AeroChamber® should be replaced when the small gray rubber flap valve is cracked, hard, or gets permanently curled, if the rubber opening of the AeroChamber® becomes cracked or torn, or if the mask is damaged or has a hole in it.
- To avoid dust accumulation, keep your AeroChamber® in its plastic container when not in use.
- Rinse the AeroChamber® in warm tap water every few days, and clean weekly with a mild detergent. Let dry thoroughly before using.
- Rinse plastic holder of MDI regularly with warm tap water. Remove canister from holder before rinsing. Let dry thoroughly before replacing the canister.
- To check the level of medication remaining in your MDI, remove the metal canister from the plastic holder. Placing a finger on the top of the canister, gently shake, feeling for liquid moving within the canister. When little liquid movement can be felt, the MDI is almost empty.
IF DESPITE YOUR BEST EFFORTS YOUR CHILD'S BPD IS NOT WELL CONTROLLED OR WORSENS, PLEASE SEEK MEDICAL ATTENTION IMMEDIATELY.
Nebulizers and Compressors
Aerosol Treatments by NebulizerInhaled medications are given by nebulizer most often in children who don't respond when asthma medications are given by cheaper and more portable alternatives, such as metered-dose inhalers with a spacer device. If you have a nebulizer at home and another asthma inhaler, and your child responds better to his Reliever medication when it is given by nebulizer, you should use the nebulizer during asthma attacks. Note: There are many different nebulizers on the market. You should check your instruction manual or ask the company that supplied your nebulizer for exact instructions on how to use your nebulizer and compressor.
What are all the different parts of a nebulizer?
compressor — an electric air compressor
nebulizer kit — consists of:
- a medication reservoir (cup): this holds the medication, and has special ducts to vapourize the medication. A cap attaches to the top of the cup, and a tube attaches to the bottom of the cup.
- cap — this attaches to the top of the cup.
- tubing — this connects the nebulizer (cup) to the air compressor.
- mask — a soft face mask which attaches to the top of the cap. Masks are available in children's, and adult sizes. The mask is held against the child's face, so that the medication mist can be breathed in by the child
OR
- mouthpiece — this attaches to the top of the cap. The child places his lips around the mouthpiece, and breathes hrough it. The mouthpiece is preferable in children old enough to understand how to use it.
- medication — a syringe may be required for measuring the medication (make sure a health care professional teaches you how to read the medication dose on the syringe). Once the medication is opened, it should be stored in the refrigerator, and any unused medication discarded after one month. Some medications may be given in combination — check with your physician or pharmacist. Some medications come in pre-mixed little containers, called ampules or nebules, or unit-dose vials.
How to Use a Nebulizer
- Wash your hands.
- Measure the desired amount of medication, being careful to remove any airbubbles, and put it into the nebulizer cup. Measure and add the normal saline, if required.
OR
- If you're using a pre-mixed nebule, open the top of the nebule and dump all of the liquid (or give the amount ecommended by your doctor) into the cup.
- Attach the cap to the nebulizer cup. Attach the mask or mouthpiece to the cap.
- Attach one end of the tubing to the bottom of the nebulizer cup.
- Connect the other end of the tubing to the air outlet connector on the compressor.
- Plug in and turn on the compressor.
- Holding the nebulizer upright, put the mask onto the child's face. If using a mouthpiece, and instruct the child to seal his/her lips around the mouthpiece and breathe normally by his/her mouth.
- When the liquid is gone from the cup, and there is no more aerosol produced (usually about 15 minutes, depending on the amount of medication), remove the nebulizer, and turn off the compressor.
CleaningAfter each treatment, take apart the nebulizer kit. Rinse the nebulizer cup, cap and mouthpiece/mask, and syringe. Allow to air dry completely before reassembling. The tubing does not need to be cleaned.
Once per day wash the nebulizer cup, cap, mouthpiece/mask and syringe in lukewarm soapy water (mild dish detergent). Rinse well, and allow to air dry completely.
Some nebulizer kits are dishwasher safe — but check first with the manufacturer's instructions or your home care provider.
Remember that most children's asthma is aggravated by upper respiratory infections, or "colds", so it is essential to keep the supplies clean.
The Care and Feeding of your Home CompressorIt is a good idea to unplug the compressor when not in use. Keep the compressor in a dust-free area. Most compressors have an air intake filter, which discolours as it gets clogged. The filter is easy to change (Check the Operator's Manual for your compressor). If the compressor becomes hot during use, and/or if the treatment takes longer to nebulize, then the compressor may require service. Most compressors are waranteed by the manufacturer 3 to 5 years. Check with your Home Care company for service.
TroubleshootingNo aerosol output
- Check that the tubing is firmly attached to the nebulizer and compressor.
- Try another nebulizer (they are sometimes defective); It is seldom that it is a problem with the compressor.
The tubing keeps popping off
- Check that the tubing is not kinked.
- Check that the air duct into the nebulizer cup is clear.
- Change the tubing (sometimes it becomes worn at the connections).
HintsDecide on your equipment needs carefully. You may want to lease equipment.
Check with your Extended Health Insurance or Drug plan about your coverage.
If the medication is refrigerated, it should be warmed to room temperature before it is given, because cold air can aggravate asthma symptoms. An exception to this is if the child has "croup" (barking cough) the cool mist can help reduce airway swelling.
Some medications can be combined in the nebulizer cup, eliminating the need for normal saline and multiple treatments. Check with your doctor or pharmacist.
If your child is receiving an inhaled steroid, have him/her mouth rinse or offer a drink following the treatment. This reduces the risk of yeast infection, a possible side-effect of inhaled steroids. If the child uses a facemask, wipe the child's face. This reduces the risk of a rash on the face.
If you use a syringe to measure your medication, you may wish to use an indelible marker, nailpolish or waterproof tape to carefully mark the desired fill line on the syringe. This needs to be changed if the dose of your child's medication changes.
Travel TipsIf you are traveling abroad, be sure to have a transformer, and an adequate supply of medications (in the original packaging).
If you are traveling by car, and/or enjoy camping, there are compressors which will plug into a car lighter. In general, these compressors are not as powerful as electric mains units. Check with your vendor — you may be able to lease one for your vacation needs.
Many of the medications for use in home nebulizers are available in unit-dose ampoules, eliminating the need for normal saline and syringes. Although they are more expensive, they are easy to use, and do not require refrigeration. This makes them handy for caregivers, schools, camps, and/or travel. They may, in fact be more economical for infrequent use, since less medication is discarded.
Commonly Asked QuestionsQ: My baby always cries during the treatments. Does this hurt?
A: No, and a crying child is breathing deeply. Try to persist, and the child will become used to the treatments. It may be helpful to allow the child to play with the mask in between treatments, to familiarize him/herself with it.
Q: My infant always falls asleep following the aerosol treatment. Is there any sedation in the medication?
A: No. Infants often tire from the increased work of breathing, and cry throughout the treatment. The rhythmic sound of the nebulizer, combined with the eased breathing, provide conditions for a contented sleep.
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