In children special aspects have to be considered concerning the application of inhaled medications. Aerosol therapy in young infants and toddlers traditionally has been applied via nebulizers. These have particular disadvantages, e.g. large size, requirement of electric power or time-consuming application. Additionally after prolonged use nebulizers deteriorate technically leading to a reduction of breathable particles. With insufficient hygienic maintenance microorganisms e.g. Pseudomonas aeruginosa, can be cultured frequently from drug reservoirs.

However since treatment with nebulizers is no more effective than the use of metered-dose inhalers (MDI) with attached spacers therapy with other devices should be preferred. Only if young children refuse application of a spacer device (facemask) treatment with a nebulizer is indicated. Nebulizers must also be preferred, when children cry or struggle because output from spacers under these conditions is next to nothing.

In children under the age of 6 years inhalation therapy using a MDI plus spacer has become the gold standard of therapy in asthma. Overall no differences are observed between metal spacers or plastic devices washed in detergent in order to reduce electrostatic charge. However since parental preference determines treatment compliance most parents prefer smaller and more robust spacers.

Children above the age of 6 to 7 years can use dry powder inhalers reliably. For the use of these devices it is essential to generate sufficient high inspiratory flow rates. DPIs like Diskus® or Turbuhaler® have been widely used in school-aged children and adolescents. However it has been shown that even children aged only 4-5 years are able to generate an adequately high flow through the Novolizer®. Therefore inhalation therapy in children older than 5 includes both alternatives: breath-actuated devices or MDIs with spacer.


Brand PLP. Inhalation therapy in children with asthma. 2000. Minerva Pediatr; 52: 137-142

Vogelberg C, Kremer HJ, Ellers-Lenz B, Engel M, Maus J, Conrad F, Hermann R. Clinical evaluation of the peak inspiratory flow generated by asthmatic children through the Novolizer. 2004. Respiratory Medicine; 98: 924-931