Inhalers and nebulizers are two different devices used to deliver rescue or controller asthma medications directly into the lungs.

Inhalers are portable, handheld devices that are available in two types:

    1. Spray mist inhalers are like mini-aerosol cans, which push out a pre-measured spray of medicine. When the person squeezes the inhaler, a measured “puff” of medicine is released. Some metered dose inhalers (MDIs) have counters that indicate how many doses remain. If there’s no counter, the number of doses already used should be tracked, so that the inhaler can be replaced on time.

Kids who use a metered dose inhaler also may use a spacer (common brand AeroChamber), which attaches to the inhaler and makes it easier to use. A spacer is a kind of holding chamber for the medicine, which eliminates the need to closely coordinate squeezing the inhaler and inhaling the medicine. With an inhaler and spacer, the medicine can be inhaled slowly when the user is ready. So, it’s possible for very young kids and even babies to receive their medications using a metered dose inhaler with a spacer. Spacers also make inhalers more effective. Without a spacer, the medicine will reach the back of the throat but not get down into the lower airways. A spacer helps to deliver the medicine into the lower airways, which is where it needs to go to work properly. Babies and younger kids use a facemask (a plastic cup that covers the mouth and nose) to inhale the medication held in the spacer, whereas older kids can use a mouthpiece. It usually takes a few minutes to take in the medication.

  1. Dry powder inhalers deliver medicine in powder form, but powder inhalers don’t spray out. The user must do more of the work, by inhaling the powdered medicine quickly and quite forcefully (which is often difficult for very young kids).

Nebulizers are electric- or battery-powered machines that turn liquid asthma medicine into a fine mist that’s inhaled into the lungs. The user breathes in the mist through a mouthpiece or facemask. Nebulizers vary in size and shape, but can be a bit bulky and noisy and may need to be plugged in. A child doesn’t have to “do” anything to receive the medicine except stay in one place and accept the mouthpiece or facemask. It usually takes about 5 or 10 minutes to give medication by nebulizer, and sometimes longer. If you are concerned your child may be overweight, start by making an appointment with Dr. Eisner.

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Table 1 is for the bronchodilator medicine Albuterol. Bronchodilators are medications which open up constricted bronchial tubes. When asthmatic patients breathe and move air through constricted airways which produce increased mucus, they may experience symptoms of wheezing, labored breathing, or “coughing fits”.  Albuterol inhalers are intended as “rescue medicines” to “open up the bronchial tubes” and thereby alleviate acute symptoms of wheezing, labored breathing or “coughing fits”. Albuterol inhalers are not intended to be used on a chronic basis for control of these symptoms.

Albuterol is the generic name, and many names for “Albuterol-type medication” are listed in this table, including Xopenex (levalbuterol). Xopenex is the “racemic isomer” of Albuterol. Drugs which are racemic isomers are thought to have less side effects. In particular, Xopenex may have less of the side effects of jitteriness or an increased heart rate experienced by some patients on Albuterol. As shown in this table, Albuterol and levalbuterol may be given in an inhaler, or an equivalent amount may be given in a nebulizer.

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Table 2 is for inhaled steroids, or what are referred to as ICS (inhaled corticosteroids). This table shows the ICS of different names, and the comparable doses which can be given in a nebulizer. Inhaled steroids are low dose steroids targeted directly at the lungs, intended to help the inflammation which causes the symptoms of asthma to persist. ICS should be used to control asthmatic symptoms when flare-ups of asthma are more than occasional, and cause more chronic or persistent problems shown ICS have many benefits. First and foremost, they may help your child to achieve control of your child’s asthmatic symptoms. Second, it is far preferable to use low-dose inhaled steroids to achieve control than to have flare-ups which require oral or injections of steroids which are much higher dose than ICS. Third, ICS is thought to prevent the “re-modeling” of inflamed lungs caused by poorly controlled asthma.

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Table 3 illustrates another option for patients with persistent symptoms of asthma—acombination inhaler of an inhaled steroid (ICS), and what is essentially a long-acting inhaled bronchodilator similar to Albuterol (they go under the names salmeterol, etc). The combination inhalers should make the use of inhaled Albuterol largely unnecessary, except for asthma flare-ups, inhaled Combination inhalers are often very effective in helping persistent asthmatics achieve good control, and have the advantage of twice daily dosage. Steroid inhalers should not be used with combination inhalers.

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The table includes the comparable dose of steroids in combination inhalers or diskus with steroid only inhaled diskus in an inhaler for those who prefer not to use a combination inhaler, or go back and forth between combination and non-combination inhalers.

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