Inhaled medication (e.g. bronchodilators and anti-inflammatory drugs) are safer and more effective than oral drugs. They are best given to children using a spacer. A spacer is a container that is placed between the metered dose inhaler (MDI or ‘puffer’) and the patient’s mouth. This allows the drug to mix well with the air in the container before it is inhaled. In this way the drugs are better absorbed through the linings of the airway.

The inhaler is pushed through a hole made in the bottom end of a 500 ml cooldrink bottle while a face mask is attached to the mouth of the bottle. This home-made spacer works well and is much better than a small plastic or polystyrene cup.

For older children the child places her mouth directly over the top of the bottle rather than using a face mask. The child then breathes normally into the bottle.

Specially designed commercial spacers are available but they are expensive. A face mask is needed in young children. Older children should use a mouthpiece.

Metered dose inhalers can be used in children of 8 years or more when they are able to co-operate and use the inhalers correctly. Spacers are used for younger children.

Nebulisers can be used in hospital to very efficiently give inhaled drugs. The drug in liquid form is added to the nebuliser which produces a fine mist. The dose is usually 1 ml of drug with 1 ml of saline.