Brand P L
Department of Paediatrics, Isala Klinieken/Weezenlanden Hospital, GM Zwolle, The Netherlands.
Minerva Pediatr. 2000 Mar;52(3):137-42.
Current consensus guidelines advocate the use of inhalation therapy for all children with asthma. In this paper, the published evidence on technical and practical aspects of inhalation therapy in children with asthma is reviewed. For children under 6 yr of age, nebulizers and metered dose inhaler (MDI)/spacer combinations can be used. Nebulizers are cumbersome, bulky, and difficult to operate. They require technical and hygienic maintenance. A number of studies has shown that nebulizers are no more effective in delivering bronchodilator therapy than MDI/spacer combinations. Thus, for young children with asthma, MDI/spacer combinations are the device of choice for inhalation therapy. Due to static charge, the output from plastic spacers is lower than that from metal spacers. Static charge on plastic spacers can be reduced by washing the spacer in detergent and allow it to drip dry. Most children aged 6 yr or over can use a dry powder inhaler (DPI) reliably. Modern DPIs require relatively low inspiratory flow rates for proper operation. Lung deposition from the Turbuhaler is twice as high as that from the Diskus, but the former device is slightly more difficult to operate than the latter. Many children with asthma have a poor inhalation technique. Because a reliable inhalation technique is the key to successful inhalation therapy, inhalation technique should be instructed carefully and checked repeatedly in every asthmatic child using an inhaler device.
当前的共识指南提倡对所有哮喘儿童使用吸入疗法。本文对已发表的关于哮喘儿童吸入疗法技术和实际操作方面的证据进行了综述。对于6岁以下的儿童，可以使用雾化器和定量吸入器（MDI）/储物罐组合。雾化器笨重、体积大且操作困难。它们需要技术和卫生维护。多项研究表明，在提供支气管扩张剂治疗方面，雾化器并不比MDI/储物罐组合更有效。因此，对于患有哮喘的幼儿，MDI/储物罐组合是吸入疗法的首选装置。由于静电，塑料储物罐的输出低于金属储物罐。塑料储物罐上的静电可以通过用洗涤剂清洗储物罐并让其滴干来减少。大多数6岁及以上的儿童可以可靠地使用干粉吸入器（DPI）。现代DPI需要相对较低的吸气流量才能正常操作。都保的肺部沉积量是准纳器的两倍，但前者的操作比后者略难。许多哮喘儿童的吸入技术较差。由于可靠的吸入技术是吸入疗法成功的关键，因此对于每个使用吸入器装置的哮喘儿童，都应仔细指导并反复检查其吸入技术。
