Hi
I'm new here and am feeling a deep sense of relief to be amongst others who can talk about asthma in this way... I'm going to make my first post about how the preventers and relievers are taken. Does anyone have any thing to say about whether spacers or nebulisers are more effective? I've had conflicting advice from 2 very senior Peds. I'll mention my asthmatic child is 3 as it is probably relevant.
Thanks for reading.
HI Ali,
Spacers work as effectively as nebulisers. Usually nebulisers deliver higher doses of inhaled medicines than spacers. Most times spacers are prescribed for children and young people who find it difficult to use their aerosol inhaler. Spacers make the inhaler easier to use and more effective. They also help to deliver more medicine into the lungs than just using your inhaler on its own.For a child 3 years old, i guess a spacer would be ok. you can discuss with your doctor, asthma nurse, or pharmacist which one of the two would be best for your child if you are uncertain.
Regards Pearl.
Thanks for your reply Pear. I have had one consultant say my daughter isn't inhaling enough from her spacer, and another say she's doing it fine and anyway a spacer is more effective than a nebuliser, except when she's having an attack and she always has neb Salbutamol as she needs more than the ihaler gives her. I'm just interested to see if others have been told the spacer method is only effective if the child is inhaling properly.
Hi - I don't know about the situation for children so this reply is for my situation as an adult. I've been told that a spacer is as effective as a nebuliser. I have two spacers - the aerochamber and a volumatic. I use the aerochamber to take my everyday meds (I'm on a very high dose steroid so it has to be taken through the spacer) and the volumatic when I'm having an attack and need higher doses of salbutamol.
I've been told that multiple puffs through the volumatic spacer will have the same effect as a nebuliser and if I'm not getting relief that way, that's when I need extra help - A&E - and that a nebuliser would just give me a false sense of security and delay going to the hospital which could potentially be dangerous.
This advice makes sense to me and I have no reason to doubt my GP/Nurse/Consultant - the only thing the causes a few questions in my mind is that if I'm having problems and I'm at the GPs they stick me straight on a neb rather than use my spacer which would suggest that they think that to be more effective? - That does confuse me a bit.
Asthma UK's children's holidays have an action plan that we have to follow if any of the children have an asthma attack, and it doesn't include the use of a nebuliser.
I believe that research has shown that an inhaler through a spacer is just as good a way to deliver medication as a nebuliser is. The main benefit of a nebuliser is that you just strap the mask on and breathe as best you can, whereas with a spacer you need to time your breath in to the pressing of the inhaler, and you can't really use it as effectively if you are struggling to breathe.
While what you're all saying is rassuring, I'm still unsure as I have also been told that a nebule (for a child my daughter's age 2.5mg) is a stronger dose than used in an inhaler but surely that depends how many puffs are given. Also when she is really poorly the doc and hosp staff use nebs instead of spacer until she is stabalised. Anyway, when she has her attacks the only relief she gets is via the nebuliser, using her inhaler via a spacer is not effective but her technique is assessed regularly by her asthma nurses and consultants. She has tracheal stenosis (narrow windpipe) too so maybe that's why it works better for her. I feel if she was always using her spacer then she would definitely be admitted more often... hmmm.... definitely one to talk through with her doctors again.
Ali, you're absolutely right. You can't compare the doses in a nebule to those in one puff of an inhaler because you can give a number of puffs on an inhaler. If anything, an inhaler is the *quickest* way to get a higher dose of meds.
As has been said below, you can't compare dosages, but research does show that the spacer is just as effective as nebs.
Also spacers are shown to improve the amount of medication you inhale if you use one for all your daily inhalers, so making them more effective, and that is for all users.
Peaksteve, can you explain what you mean by: ""with a spacer you need to time your breath in to the pressing of the inhaler""? One of the reasons I use a spacer is that I have terrible co-ordination (I'm dyspraxic amongst other things) and was told that the spacer overcame the issue of timing breathing and inhaler operation. Now I'm a bit worried I've misunderstood and haven't been using it properly. Thanks.
I think when an attack is taking place it may be difficult for the person to concentrate properly on using a spacer and counting the breaths you need to take in etc therefore a nebuliser is preferable in an emergency to use for its simplicity of just as Peaksteve said to put the mask on and inhale the medication. For a child if a parent is delivering the medication through the spacer, then this isn't as much of an issue I think.
From what a nurse once said to me (and this is going back about 5 years ago so I don't know if it still holds true) 8-10 puffs of Salbutamol (blue reliever inhaler) through a spacer in an attack is the equivalent to 1 nebuliser treatment. And if this wasn't to work to seek medical attention immediately.
Yes I've been told that timing isn't an issue with a spacer but that 10 breaths or 15 seconds between puffs is about right for kids, don't know for adults. That's why they are so much better for children and adults who find the timing difficult without the spacer.
Yes, I should perhaps clarify the ""timing"" statement - it wasn't very clear in the way I originally posted it.
If you're using an inhaler without a spacer, timing the press of the inhaler with your breath in is obviously crucial. With a spacer, you have a very much larger window of ""opportunity"" between pressing the inhaler and needing to breathe in. However, you do not have an unlimited amount of time, and you still need to be able to take in a comparatively deep breath in order for the meds to be delivered correctly. With a nebuliser, these two issues are effectively removed - you don't need to time *anything* and you don't need to be able to take a deep breath in.
Got it, yes that makes perfect sense. Also the consultant paed who first questioned her technique did say her inbreath wasn't as strong as it should be to max the benefit from the ihaler with spacer. Thanks everyone, your input has been very useful.
My daughter is 10 and is a brittle asthmatic and is always in and out of hospital...it is our second home! She has very severe attacks which almost always lead to her having to have aminophylline and a trip to HDU, she isn't allowed an nebuliser at home as her respiratory specialist says that it will give me a faulse sense of security as it is the oxygen that brings her back up not the medication, she has nebulisers through the aerochamber or spacer at home when she needs it, if she doesn't pick straight up we go to hospital, she has open door access to the paeds unit so it's really easy. She is on daily pred and very high dose steiroid inhailers and we still can't control her asthma, they are really worried that she will have a fatal attack which is why i'm quite glad that she doesn't have the nebuliser at home to be honest, her specialist says that if she is ill enough to have a nebuliser then she should be in hospital really anyway. I'm just holding out for the next two years when she can have the anti IgE injection
Recommend a nebuliser please
Nebuliser question 
Nebuliser recommendations?
