Nebulization Therapy for Asthma: A Practical Guide for the Busy Pediatrician

International expert opinion on the use of nebulization for pediatric asthma therapy during the COVID-19 pandemic

“…International expert opinion on the use of nebulization for pediatric asthma therapy during the COVID-19 pandemic Guidelines, including those from GINA, recommend the use of pressurized metered dose inhalers (pMDIs) plus a spacer, as an alternative to nebulizers (1)(2)(3)13). However, asthma drug administration by nebulization has many medical benefits compared with administration by pMDI as it allows co-administration of other compatible medications, administration of high doses of medication and furthermore, oxygen could be used as the driving force for nebulization in patients with acute exacerbation and severe hypoxemia (14)(15)(16)(17)(18). Nebulization is also a more user-friendly method compared with drug delivery by pMDI as it requires minimal patient cooperation, does not require patients to hold their breath, permits easy dose adjustments and is straightforward to use (14,19,20).…”

The Science Guiding Selection of an Aerosol Delivery Device

“…Nebulizer design changes over the past decade have created different nebulizer categories. 7,8 Figure 2 pictures the 4 different classes of pneumatically powered nebulizer: jet nebulizer with reservoir tube, jet nebulizer with collection bag or elastomeric reservoir ball, breath-enhanced jet nebulizer, and breath-actuated jet nebulizer.…”

“…Jet nebulizers, due to their design, emit aerosol to the ambient air during the expiratory phase and any time when the patient is not breathing. 8,9 Jet Nebulizer With Collection Bag or Elastomeric Reservoir Ball. This class of SVN creates aerosol particles by continuously filling a reservoir (see Fig.…”

“…A built-in reservoir with a one-way inspiratory valve allows the patient to inhale medication from the reservoir, and exhales to the atmosphere through an exhalation port between the one-way inspiratory valve and the mouthpiece. 8,9 Breath-Enhanced Jet Nebulizer. Breath-enhanced nebulizers utilize 2 one-way valves to prevent the loss of aerosol to the environment (see Fig.…”

The differential diagnosis and management of asthma in the preschool‐aged child

“…The NP can follow a standardized checklist listing the key steps for proper device use. The checklist will depend on the device; checklists or guides have been published for MDIs with spacers (Chan, 2006;NAEPP) and nebulizers (Welch, 2008).…”