Frequency of inhalation2 [refers to Q/A Frequency of inhalation]

Question

We do not practice inhalation with a spacer – I do not know what that is!?

We inhale twice with the stated drugs, and our treating doctor insists that we inhale twice so that our daughter is covered well. As an inhalation device, we use the Pari master®, which has been recommended to us for being most effective.

The inhalation frequency is a problem in so far as my daughter is stressed out very often and we have to pull out all the stops then in order to do the therapy well.

Some parents told us that we expect too much of our daughter if we inhale and flutter twice [translator’s comment: not sure if it should be “inhale twice and flutter” instead]. Of course we want the best for our child, but at the same time we do not want to stress her out unnecessarily.

Many thanks for your commitment. It is very convenient for me to get an extra opinion in this way.

Answer

Dear parents,

I will gladly comment on your concern from a physiotherapist’s perspective. It is certainly advisable to do an intensive inhalation therapy for the lungs. However, it is understandable from a child’s viewpoint that your daughter does not always enjoy this very much.

From my experience, I think (and I second Dr. Rietschel in this) that it is okay to just do the saline inhalation once a day. From about 3 or 4 years, children can be introduced to liquid inhalation with a mouthpiece. A combination of liquid inhalation and the flutter makes sense for time saving reasons. From a physiotherapy perspective, it is important that your child accepts the inhalation therapy long-term and performs it effectively. Therefore it certainly makes sense to reduce the saline inhalation therapy (that is, only once a day) during infection-free intervals.

Liquid inhalation with the Pari eFlow rapid® could perhaps be an option for your daughter.

A spacer is a box that is placed before an inhaler (also called expander or distance piece). In this way, it is no longer necessary to coordinate the inspiration with the triggering of the puff (more effective deposition of the agent in the lungs). For children, this is the simplest option to inhale more quickly and in the right way.

I hope to have answered your question adequately.

Kind regards
Kathrin Könecke, physiotherapist

23.11.2009

23.11.09 This Q/A seems to be from the same questioner who asked "Frequency of inhalation"; this was answered by Dr. Rietschel, he assumed that the mentioned drugs beclomethasone and salbutamole were inhaled via a spacer/aerochamber; but obviously, the questioner does even not know what that is and everything is inhaled via Parimaster; so another option could have been in that answer to let the drugs becomethasone and salbutamole be inhalted via aerosol plus spacer, which is much quicker than inhalation via PariMaster.
D. d'Alquen