Get Smart About Asthma

4 Common Asthma Medication Mistakes

It's a major problem: Most kids don't use their inhaler properly. And when the drug doesn't get into the lungs, it won't work. Here's how to correct what often goes wrong.

Mistake #1: Your child doesn't capture enough mist.

A standard metered-dose inhaler (MDI) shoots a mist of medication into the air that can be tough to breathe in at exactly the right moment. Attachable plastic spacers capture the medicated spray, but if a child doesn't start inhaling within one or two seconds, the spray sticks to the interior lining, says Dr. Berger, author of Asthma for Dummies.

Solution: Attach the inhaler to a spacer and make your best effort to have your child inhale as soon as you pump the inhaler. Some models, such as the AeroChamber, are available with a face mask. Use a spacer whenever your child uses her medication at home, and also leave one with the nurse at school.

Mistake #2: She's breathing incorrectly.

A child needs to inhale slowly and deeply from an MDI for several seconds and then hold her breath for up to 10 seconds so medicine penetrates into her airways. "Most children can't do it properly until age 4 or 5," says Dr. Berger.

Solution: Kids up to age 6 who lack the coordination to properly inhale the medicine with an MDI should use a nebulizer, which dispenses medication in a mist that they can breathe normally through a face mask or a mouthpiece. When your child is 5 or older, ask your doctor whether she's ready for an inhaler.

Mistake #3: You don't check your child's technique.

Being "old enough" still won't guarantee that he uses his inhaler correctly. For example, some younger children have trouble drawing in air forcefully enough to use a dry powder inhaler (DPI), which requires them to inhale quickly and forcefully. And using the new environmentally friendly HFA inhalers (traditional chlorofluorocarbon inhalers will be banned as of January) "feels" different, so kids often don't think they're getting enough medication.

Solution: Ask a nurse or doctor to give your child a refresher course on how to use his inhaler, and make sure he's using it properly before you leave the office. If your child uses a DPI, ask your doctor to check how forcefully he's breathing with a special training device that whistles when it's used properly.

Mistake #4: You try to stretch the medicine.

It's tempting to economize by trying to get the last bit of medicine out of an inhaler, but your child may not get the full dose when a canister is nearly empty.

Solution: Keep track of doses so you know when you're low. Some corticosteroid medicines like Flovent HFA, DPIs like Pulmicort Flexhaler, and rescue medicines like Ventolin HFA have a built-in dose counter. For others, estimate how many days the canister should last, and mark the date on your calendar. You can also stick a blank label on the inhaler and mark it every time your child takes a puff, or buy a separate electronic counter such as the Doser ($28; doser.com).

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