Inhalational Therapy in Childhood – Bronchial Asthma: Myth Vs Facts

3-year-old Abhro is suffering from recurrent cough, wheezing, and breathlessness since six months of age. He required nebulization & hospitalization many times.

• 2-year-old Anik suffers from frequent cough & cold, 1-2 episodes every month
• Diya, 18-month-old, rubs her nose & eyes too much, gets sneezing & cold too often
• Sneha gets cough with breathlessness frequently, along with itchy skin eruptions which keep on coming in crops.

All these kids belong to the spectrum of childhood atopy which encompasses all – allergic rhinitis – atopic dermatitis –bronchial asthma etc. These days, incidence of childhood atopy is on an alarming rise.

No wonder that the parents of atopic kids expect the pediatrician to prescribe some cream for their skin allergy. But when the doctor prescribes some ‘Inhaler’ for their allergic cough / breathlessness, parents tend to get apprehensive. Their fear?

• No further chance of cure
• Dependence on inhalers
• Lots of side effects
• Stamping the child as asthmatic
• Last step of treatment

But the facts are diametrically opposite. This is why:

• Improved chance of cure
• Like a cream for skin lesion, inhalational therapy is also a form of topical therapy, i.e it bypasses the oral route and has maximum effect on the targeted organ – in this case, the lungs and airways. So its efficacy is far more than an oral agent
• Since rest of the body is spared from the inhalant, its side effect is the least
• A dose of inhalant is about 1/1000^th of an oral medicine
• Inhalers are safe for kids with obesity and liver/skin/heart ailments, where traditional medicines tend to pose risk

Inhalants can be divided into 2 categories:

1. Preventers-

• Prevents acute exacerbation
• Gradually modifies the disease process – pave the pain of recovery
• Have to be used daily
• Provide a symptom free life
• STEROID is the mainstay of preventers

2. Relievers :

• Brings relief during breathing trouble
• When used in the early phase of an asthmatic attack, relievers can reduce chances of hospitalization
• Not meant for regular use. Those in need of relievers frequently should go for regular use of preventers, instead

Many parents prefer relievers over preventers in order to

• Avoid daily modification (e curtail test)
• Avoid steroid (and the associated taboo)

But this is dangerous because –

• More the number of asthmatic attacks, lesser are the chances of outgrowing the disease
• Life-threatening asthmatic attack can occur at any time

Doctors prescribing inhalers should spend a good time not only discussing the ‘pros’ of inhalers, but also the ‘types’ and timing of their usage.

Few suggestions for those using inhalers:

• Rinse mouth or sip water after taking inhalers
• Proper cleaning and storage of the equipment
• Use of spacer device is always preferable
• Check if the canister is empty before administering dosage
• Know which inhaler is a preventer and which a reliever, and then use accordingly
• Ensure proper administration
• Avoiding environmental triggers is of utmost importance

Dr Krishnakali Bhattacharya `

Consultant- Pediatrics

Narayana Multispeciality Hospital, Barasat