Metered-Dose Inhalers (MDIs) and Spacers

Metered-Dose Inhalers (MDIs) and Spacers in Pediatrics

MDIs with spacers are essential devices for delivering aerosolized medications in pediatric respiratory conditions. They combine the precision of metered-dose delivery with the convenience of spacer devices to optimize medication administration in children.

Key Components:

  • Pressurized canister containing medication
  • Actuator (plastic body with mouthpiece)
  • Spacer device with valve system
  • Face mask (for younger children) or mouthpiece

Clinical Indications

Primary Uses:

  • Acute asthma exacerbations
  • Chronic asthma management
  • Exercise-induced bronchospasm
  • Bronchiolitis (in specific cases)
  • Cystic fibrosis

Age-Specific Recommendations:

  • 0-3 years: MDI with spacer and face mask
  • 4-6 years: MDI with spacer (face mask or mouthpiece)
  • ≥7 years: MDI with spacer mouthpiece

Administration Technique

Step-by-Step Procedure:

  1. Preparation:
    • Remove cap and shake inhaler vigorously (10-15 times)
    • Prime if new or unused for >1 week
    • Attach spacer device
  2. Position:
    • Sitting upright or standing
    • Head in neutral or slightly extended position
  3. Administration:
    • Exhale completely
    • Place mouthpiece/mask with good seal
    • Actuate one puff into spacer
    • Inhale slowly and deeply (or take 5-6 normal breaths with mask)
    • Hold breath for 5-10 seconds if possible
  4. Post-administration:
    • Wait 30-60 seconds between puffs
    • Rinse mouth after corticosteroids

Critical Points:

  • Ensure proper seal between face and mask/mouthpiece
  • Maintain calm breathing pattern
  • One actuation per breath sequence
  • Regular cleaning of spacer device

Types of Devices

Spacer Devices:

  • Valved Holding Chambers (VHC):
    • AeroChamber®
    • OptiChamber®
    • Volumatic®
  • Simple Spacers:
    • Basic tube extensions
    • Limited valve function

Common Pediatric MDI Medications:

  • Short-acting β2-agonists:
    • Salbutamol (Albuterol)
    • Terbutaline
  • Inhaled Corticosteroids:
    • Fluticasone
    • Beclomethasone
    • Budesonide
  • Combination Therapies:
    • Fluticasone/Salmeterol
    • Budesonide/Formoterol

Advantages and Limitations

Advantages:

  • Improved drug delivery compared to MDI alone
  • Reduced oropharyngeal deposition
  • Less coordination required
  • Decreased side effects
  • Cost-effective
  • Portable and convenient

Limitations:

  • Requires proper technique for optimal efficacy
  • Regular cleaning and maintenance needed
  • Bulkier than MDI alone
  • Static charge can affect drug delivery
  • May be difficult with uncooperative children

Troubleshooting

Common Issues and Solutions:

Problem Solution
Poor mask seal
  • Check mask size
  • Ensure proper positioning
  • Consider alternative mask type
Medication build-up in spacer
  • Regular cleaning
  • Check for valve dysfunction
  • Replace if damaged
Child resistance
  • Use distraction techniques
  • Practice during calm periods
  • Consider different device type

Maintenance Guidelines:

  • Weekly cleaning with warm soapy water
  • Air dry without rinsing
  • Replace spacer every 6-12 months
  • Check valve function regularly


Further Reading
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