Is the nebuliser the best option for childhood asthma?

Five-year-old Akash woke up at midnight with a severe asthma attack. His wheeze had worsened and he was gasping for breath. His parents were used to handling his attacks but were clearly concerned this time around and rushed him to the Paediatric emergency. He was put on nebulisation treatment at periodic intervals and was a lot more comfortable by morning.

What is a nebuliser and how does it help? Dr. Vinod Chowdhry — Head, Department of Paediatrics, Fortis Hospital, Noida — says, “A nebuliser is a device that delivers medication in aerosol form to infants and young children suffering from diseases like childhood asthma and viral croup. Asthma affects the bronchial tree leading to generalised broncho constriction or narrowing thereby decreasing the flow of oxygen to the body. The aerosols delivered by nebulisers act directly on the bronchial tree, relieve constriction and improve oxygenation.”

Dr Bhaskar Raju — Former Professor of Paediatrics and Paediatric Gastroenterology, Institute of Child Health and Hospital for Children, Chennai — explains how the mechanism works: “An aerosol, as the name implies, is a mixture of air and a solution (the medication). This is broken into tiny bubbles by the nebuliser and, when inhaled, the drug is delivered directly to the tiniest airways (bronchi and bronchioles) and the innards of the lung. Earlier the drug had to be given orally or as an injection and took hours to get absorbed. Also this way, only a small fraction makes its way to the lungs and airways .The rest is wasted or creates side-effects in the other tissues that receive the drug. The nebuliser has the twin advantage of delivering the drug real time where it is wanted and, more importantly, using only a small fraction of the amount given orally or as an injection for the same or an even better effect.That means side effects are very low and more doses can be given without fear of toxic effects.”

The bottom line is that nebulisation guarantees faster even instant relief and can be used periodically and/or until complete relief is obtained depending on the condition.

For many children, the nebulisation machine can be a scary one. It is not surprising that they scream and protest during initial nebulisation treatments. Removing this fear is important in making the child comfortable, says Dr. Chowdhry. “At first, children cry because of the sound emanating from the nebulising unit. They usually overcome this after a couple of days and even enjoy it because it gives them relief. However if the child becomes very irritable, it is better to stop and restart once he/she calms down.” Dr. Raju points out that crying does not reduce the efficiency of the process. “Over time, many even ask for it as soon as they develop a wheeze.” Older children tend to understand the mechanics of the process when it is explained to them, he says.

Many parents prefer to nebulise their children at home since this is comfortable and convenient for both the adults and the kids. Doctors agree that this is safe if a doctor has taught the parent ow to use the machine, the exact dosage of the drug, the duration of the nebulisation, the periodicity and the situations in which it should be used. A basic routine should also be put in place to ensure that any infection is not transmitted through the tubing and mask of the nebuliser. Ideally the mask and tube should not be used for multiple patients, as they can spread infections. With home nebulisations, cleaning the tube and mask with antiseptic solutions periodically and thoroughly, as well as drying them before use can help overcome this problem.

Dr. Chowdhry observes that, even today, many parents associate nebuliser treatment with adult asthma and consider it “habit forming”. So they prefer not to use it for infants and children. Dr. Bhaskar Raju agrees and adds that while nebulisation helps avoid costly hospitalisation and injections, it must be reserved for severe wheezing or and asthma attacks that make breathing difficult. “It should not be used to treat any cough,” he warns.