Inhalers in Children: When to Start, Side Effects, etc.
Dr. Vinit Mehta, MD Pediatrician
Introduction
Asthma is one of the most common chronic conditions affecting children worldwide. Many parents worry about when to start inhalers, their side effects, and whether their child will need them for life. Inhalers are an essential part of asthma management, offering better control and reducing the need for oral medications. In this article, we will cover everything you need to know about inhalers for childhood asthma, including when to start, side effects, and misconceptions.
When to Start Using an Inhaler in Children?
1. Persistent or Recurrent Wheezing
If a child experiences wheezing episodes frequently (more than three times in a year) or has difficulty breathing even with minor colds, an inhaler may be recommended.
2. Diagnosed Asthma
Children diagnosed with asthma based on clinical evaluation and lung function tests need inhalers for better control and symptom relief.
3. Exercise-Induced Asthma
If a child experiences coughing, wheezing, or breathlessness during or after exercise, a bronchodilator inhaler like Levolin may be prescribed before physical activity.
4. Nighttime Symptoms
Frequent nighttime cough, wheezing, or breathlessness indicates poor asthma control. Regular use of inhalers can help prevent nocturnal symptoms.
5. Emergency Room Visits
A history of hospital admissions or ER visits due to asthma attacks is a strong indication for inhaler therapy.
Types of Inhalers Used in Childhood Asthma
1. Reliever Inhalers (Bronchodilators)
- Example: Levolin (Salbutamol)
- Used for quick relief during an asthma attack
- Works by relaxing airway muscles
- Should not be overused; seek medical help if needed frequently
2. Controller Inhalers (Steroids & Combination Therapy)
- Example: Budecort (Budesonide), Foracort (Formoterol + Budesonide)
- Used daily to reduce inflammation and prevent attacks
- Not for immediate relief but essential for long-term control
3. Leukotriene Receptor Antagonists (Tablets, not Inhalers)
- Example: Montair LC (Montelukast + Levocetirizine)
- Reduces allergic triggers of asthma
- Used as an add-on therapy
Levolin, Budecort, Foracort and Montair LS: Which one to use? Know More
How to Use an Inhaler in Children Correctly
Using an inhaler properly ensures maximum medication reaches the lungs. Follow these steps:
Toddlers (Mask + Spacer + MDI)
- Shake the inhaler well.
- Attach it to a spacer with a mask.
- Place the mask firmly over the child’s nose and mouth.
- Press the inhaler once and let the child breathe in and out normally for 5-6 breaths.
Preschoolers (Spacer + MDI)
- Shake the inhaler.
- Attach it to a spacer.
- Inhale deeply and press the inhaler.
- Hold breath for 10 seconds, if possible.
Adolescents (MDI Alone)
- Shake the inhaler.
- Exhale completely before inhaling.
- Place the inhaler between lips and take a deep breath while pressing the inhaler.
- Hold breath for 10 seconds and exhale slowly.
Internal Link: Step-by-Step Guide on How to Use an Inhaler
Common Side Effects of Inhalers in Children
Most inhalers are safe when used correctly, but minor side effects can occur:
1. Thrush (Oral Candidiasis)
- Seen with steroid inhalers (e.g., Budecort, Foracort)
- Preventable by rinsing the mouth after each use
2. Hoarseness of Voice
- Can be minimized by using a spacer with the inhaler
3. Increased Heart Rate
- More common with bronchodilators like Levolin
- Usually mild and short-lived
4. Mild Shakiness (Tremors)
- Temporary and often disappears with regular use
5. Nasal Irritation or Dryness
- Rare side effect, can be managed by proper inhaler technique
Myths and Misconceptions About Inhalers
1. “Inhalers Are Only for Severe Asthma”
Asthma severity varies, and even mild cases may require inhalers for better control.
2. “Once My Child Starts Inhalers, They’ll Need It for Life”
Inhaler use depends on asthma severity. Some children outgrow asthma and may not need inhalers permanently.
3. “Inhalers Have Too Many Side Effects”
Inhalers are safer than oral medications since they act directly on the lungs with minimal systemic absorption.
4. “I Can’t Give an Inhaler to My Child, It’s Difficult”
With proper training, inhaler use becomes easy. A spacer makes administration simple even for young children.
5. “Inhaler Medications Are Too Strong”
Inhalers deliver a precise, low dose of medication directly to the lungs, reducing the risk of side effects compared to oral steroids.
Monitoring Asthma Control with GINA Guidelines
The Global Initiative for Asthma (GINA) provides a standardized approach to assess asthma control.
- Well Controlled: No daytime symptoms, no nighttime awakenings, no activity limitation, and minimal reliever use.
- Partially Controlled: Symptoms >2 times per week, some nighttime awakenings, and occasional reliever use.
- Uncontrolled: Frequent symptoms, daily reliever use, and severe attacks.
Internal Link: GINA Assessment for Asthma Control
When to Consult a Doctor?
- If symptoms persist despite regular inhaler use
- Frequent nighttime awakenings due to asthma
- Increasing need for a reliever inhaler
- Difficulty breathing, chest tightness, or wheezing
For Top Asthma Specialist for Kids: Click Here
Conclusion
Inhalers are a vital tool in managing childhood asthma. They provide effective control with minimal side effects when used correctly. If you have any concerns about your child’s asthma, consult Dr. Vinit Mehta, MD Pediatrician for expert guidance.
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