Table 1

Choice of inhaler devices for young children

Age (years)
1–2+ 3–5
MDI+spacer and face mask1-a 1-b 1st2nd
Nebuliser1-c 1-a 3rd3rd
Breath-actuated MDIAvoidNot proven
Dry powder inhalers
 β2agonistsAvoidOccasionally useful
 corticosteroidsAvoidNot recommended
  • 1-a The mask should be applied firmly to the face if a valved spacer is used. Used with a nebuliser, the mask should be held as close to the face as practicable without undue disturbance. Any gap reduces the dose dramatically.

  • 1-b A number of spacer devices with face masks are available. The dose received varies considerably between devices and age groups. In the 1993 guidelines the coffee cup was recommended but, in view of the widespread availability of spacer/face mask devices, it should be used only for emergencies.

  • 1-c Nebulisers are rarely needed. Spacer devices are as effective, cheaper, and less time consuming for prevention and relief.