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Nebulizer Treatments for Children

By Dr. Teresa Fuller ; Updated August 14, 2017

Managing asthma in children involves a dynamic dance between preventing asthma flareups and treating them when they happen. Doctors prescribe a number of different medications for each of these functions, many directly inhaled into the lungs. A nebulizer machine, which aerosolizes the medication, is one device used to deliver medicines directly to the airways. Nebulizers deliver quick-acting medications for asthma flareups, or long-term medications that control symptoms. Nebulizers can be a convenient alternative to inhalers for children.

Rapid Symptom Relief

An asthma flareup can cause a sudden narrowing of the airways, leading to shortness of breath, wheezing and chest tightness. Reliever medications act rapidly to dilate the airways, thereby reducing these potentially life-threatening symptoms within minutes. Reliever medications can be delivered directly to the airways through a nebulizer. These bronchodilating medications, known as short-acting beta-2 adrenergic agonists (SABAs), are generally safe and effective for children of all ages. Examples of SABAs that can be administered with a nebulizer include albuterol and levalbuterol (Xopenex). The most common side effects of SABAs are a rapid heart rate and tremors.

Long-Term Control

The most important goal in asthma treatment is prevention of flareups. Inhaled corticosteroids are recommended as the first choice for daily controller medication in children with persistent asthma. By reducing inflammation associated with asthma, inhaled corticosteroids improve symptoms and lung function, decrease need for additional medication, and reduce frequency of asthma flareups and related hospitalizations. Some inhaled corticosteroids can be given daily using a nebulizer, such as budesonide (Pulmicort). The most significant risk of inhaled corticosteroids in children is reduced height. These medications also carry a very low risk of cataracts and reduced bone mineral density. In some situations, doctors recommend another daily controller medication called cromolyn, which can also be inhaled using a nebulizer.

Nebulizers vs. Inhalers

While parents of infants and young children may consider the nebulizer a convenient way to deliver asthma medication, nebulizers are not considered superior to inhalers for treatment. According to a study published in the June 2014 issue of the "Journal of Family Practice," using either device did not change the likelihood of needing hospitalization or duration of the hospital stay. In fact, people whose medicine was delivered with a nebulizer spent more time in the emergency room compared to those who used an inhaler with a spacer -- a holding chamber that makes it easier to use the inhaler. Nebulizers have a few practical disadvantages when compared to inhalers, such as higher cost, necessary maintenance and longer time for medicine delivery. Therefore, the choice of which device to use should be based on the parents' preference.

Warnings and Precautions

Asthma flareups can occur suddenly, so it is important for parents to promptly recognize the symptoms, which include wheezing, persistent cough and shortness of breath. If these symptoms occur, a reliever medication should be administered immediately. Therefore, make sure your home nebulizer machine is kept clean and ready for immediate use at all times. When away from home, bring a portable or travel nebulizer, and be sure it's accessible. If a child's symptoms continue to worsen or if reliever medications are required with increasing frequency, seek immediate medical attention.

Medical advisor: Shilpi Agarwal, M.D.

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