Pediatric Annals

Holding Chambers for Aerosol Drugs

Thomas F Plaut, MD

Abstract

We prescribed inhaled drugs (adrenergics, cromolyn, steroids, or ipratropium) for three quarters of the more than 400 children with asthma in our practice. Children ages 3 to 10 often have great difficulty timing inhalation to match delivery of the mist from the metered-dose inhaler (MDI). The bad taste of the medication accentuates this problem, for these reasons we often recommend a holding chamber (reservoir, spacer, or extender) to aid in the delivery of inhaled drugs.

All holding chambers catch the mist from the MDI and hold it until the child starts to breathe in. This eliminates the need for good coordination between release of the mist and inspiration. It allows the mist to be breathed in at a slower, more effective rate. ' In large-volume holding chambers, air dilutes the unpleasant taste of medication, making it easier to breathe in. Adverse medication effects are reduced because the large particles of medication are often trapped in the chamber before reaching the mouth. Steroid-induced thrush is reduced by 90%.2

INSPIREASE®

I call this collapsible large-volume reservoir "the accordion" because it makes a musical sound if the patient breathes in too fast. Since slow inhalation leads to greater deposition of the medication mist in the bronchioles the sound is a very helpful feedback feature. The InspirEase is collapsible and easy to carry. This is an excellent device for children ages 4 and over. Younger children may have difficulty breathing in slowly and holding their breath for five seconds (Figure 1).

Instructions:

1. Extend bag.

2. Place the mouthpiece on your tongue and puff one whiff of medication into the chamber.

3. Suck in slowly with lips snug on mouthpiece and hold breath 5 seconds.

4. Breathe out keeping lips snug about mouthpiece.

2. Puff one whiff of medicine into chamber.

3. Encourage child to inhale, raising the float to the top, if possible, ten times in a row. The slower and Higher the better. Some children get good relief with less than perfect technique.

4. Wait at least 1 minute and then repeat the whole routine.

Cost: about $15 to $20 from Key Pharmaceuticals. Requires prescription.

PAPER TUBE

Children over 5 who have difficulty coordinating the release of medication from an MDI with their inhalation will find a tube holding chamber helpful (Figure 3).

Instructions:

1. Roll a piece of typing paper to form a tube 8 inches long and 2 inches in diameter.

2. Puff one whiff of medication in, then inhale with lips snug around the tube.

3. You must start to inhale slowly within 1 second and hold your breath for 5 to 10 seconds.

4. Repeat routine after waiting at least I minute.

Advantages: low cost, availability, and portability.

AEROCHAMBER®

This superior holding chamber has a valve that prevents accidental exhalation of the medication, for best effect, the inhalation must be held 10 seconds. Repeat routine after waiting at least 1 minute.

Cost: $12 to $14 from Monaghan Medical Corporation (Figure 4). No prescription required.

1. Levison H. Reilly PA, Woisley GH. Spacing devices and metcred-dose inhalen in childhood asthma. J Pcaion 1985; 107:662-668.

2. Toogood JH. Baskcrville J. Jennings B, ei al. Use of spacers co facilitate inhaled cotticosteroid treatment of asthma. Am Rev Reipir Du 1984; 129:723-729.

TABLE I

Comparison of Holding Chambers

TABLE 2

Holding Chamber Vendors…

We prescribed inhaled drugs (adrenergics, cromolyn, steroids, or ipratropium) for three quarters of the more than 400 children with asthma in our practice. Children ages 3 to 10 often have great difficulty timing inhalation to match delivery of the mist from the metered-dose inhaler (MDI). The bad taste of the medication accentuates this problem, for these reasons we often recommend a holding chamber (reservoir, spacer, or extender) to aid in the delivery of inhaled drugs.

All holding chambers catch the mist from the MDI and hold it until the child starts to breathe in. This eliminates the need for good coordination between release of the mist and inspiration. It allows the mist to be breathed in at a slower, more effective rate. ' In large-volume holding chambers, air dilutes the unpleasant taste of medication, making it easier to breathe in. Adverse medication effects are reduced because the large particles of medication are often trapped in the chamber before reaching the mouth. Steroid-induced thrush is reduced by 90%.2

INSPIREASE®

I call this collapsible large-volume reservoir "the accordion" because it makes a musical sound if the patient breathes in too fast. Since slow inhalation leads to greater deposition of the medication mist in the bronchioles the sound is a very helpful feedback feature. The InspirEase is collapsible and easy to carry. This is an excellent device for children ages 4 and over. Younger children may have difficulty breathing in slowly and holding their breath for five seconds (Figure 1).

Instructions:

1. Extend bag.

2. Place the mouthpiece on your tongue and puff one whiff of medication into the chamber.

3. Suck in slowly with lips snug on mouthpiece and hold breath 5 seconds.

4. Breathe out keeping lips snug about mouthpiece.

Figure 1. InspirEase. ® Pedipress, Inc.

Figure 1. InspirEase. ® Pedipress, Inc.

Figure 2. INHAL-AID- * Pedipress, Inc.

Figure 2. INHAL-AID- * Pedipress, Inc.

Figure 3. Paper tube. l£ Pedipress. Inc.

Figure 3. Paper tube. l£ Pedipress. Inc.

Figure 4. Aerochamber. 'e Pedipress, Inc.

Figure 4. Aerochamber. 'e Pedipress, Inc.

5. Suck in slowly and hold breath 5 to 10 seconds.

6. Repeat steps 1 through 5 with a new puff of medication after waiting at least 1 minute.

Cost: about $9 to $11 from Key Pharmaceuticals. Requires prescription.

1NHAL-AID®

Most 3 year olds can use this large-volume device with an MDI after a few practice sessions. A special feature is the incentive marker that indicates adequate inspiration. The INHAL-AID can be used with good effect in a mild or moderate attack. Ability to hold the breath is not required. This is a very effective holding chamber for children ages 3 to 6 (Figure 2).

Instructions:

1. Place mouthpiece on tongue.

2. Puff one whiff of medication in the chamber.

3. Suck in with lips snug on mouthpiece and hold breath 5 seconds.

4. Continue to hold lips snug on mouthpiece and breathe out.

5. Suck in, hold breath, and breathe out three more times.

6. Wait at least 1 minute and repeat steps 1 through 5 with a new puff of medication.

For younger children who cannot hold their breath:

1. Place mouthpiece on. tongue with lips snug around.

Table

TABLE IComparison of Holding Chambers

TABLE I

Comparison of Holding Chambers

Table

TABLE 2Holding Chamber Vendors

TABLE 2

Holding Chamber Vendors

2. Puff one whiff of medicine into chamber.

3. Encourage child to inhale, raising the float to the top, if possible, ten times in a row. The slower and Higher the better. Some children get good relief with less than perfect technique.

4. Wait at least 1 minute and then repeat the whole routine.

Cost: about $15 to $20 from Key Pharmaceuticals. Requires prescription.

PAPER TUBE

Children over 5 who have difficulty coordinating the release of medication from an MDI with their inhalation will find a tube holding chamber helpful (Figure 3).

Instructions:

1. Roll a piece of typing paper to form a tube 8 inches long and 2 inches in diameter.

2. Puff one whiff of medication in, then inhale with lips snug around the tube.

3. You must start to inhale slowly within 1 second and hold your breath for 5 to 10 seconds.

4. Repeat routine after waiting at least I minute.

Advantages: low cost, availability, and portability.

AEROCHAMBER®

This superior holding chamber has a valve that prevents accidental exhalation of the medication, for best effect, the inhalation must be held 10 seconds. Repeat routine after waiting at least 1 minute.

Cost: $12 to $14 from Monaghan Medical Corporation (Figure 4). No prescription required.

REFERENCES

1. Levison H. Reilly PA, Woisley GH. Spacing devices and metcred-dose inhalen in childhood asthma. J Pcaion 1985; 107:662-668.

2. Toogood JH. Baskcrville J. Jennings B, ei al. Use of spacers co facilitate inhaled cotticosteroid treatment of asthma. Am Rev Reipir Du 1984; 129:723-729.

TABLE I

Comparison of Holding Chambers

TABLE 2

Holding Chamber Vendors

10.3928/0090-4481-19891201-13

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