Thursday, 13. February 2014

Inhalation therapy in children - Safe and effective with nebuliser

Nebulisers are first choice therapy in acute cases offering children a safe and reliable application of medication.

Pediatricians agree that inhalation therapy has been employed as the mainstay in the treatment of children with obstructive pulmonary diseases.

This offers a number of advantages compared to systemic therapy with fewer side effects and faster onset of action.

The efficient use crucially depends on the patient´s ability to use the prescriped system properly. Therefore, especially in children, the selection of the suitable inhalation device is the most decisive factor.

In this article, the authors Dr. Weisner and Prof. Kopp from Lübeck, Germany review different possible inhalation systems and the application of hypertonic saline (HS).

Inhalation systems

Nebuliser therapy requires no coordination between release of the medication and inspiration, contrary to metered-dose inhaler (MDI). In this way, nebulisation ensures the optimal treatment for all ages especially for children.

Tidal breathing is sufficient for a proper drug administration with nebuliser devices while dry powder inhalers require high inspiratory flow rates to achieve a therapeutic effect (Desagglomeration of the powder to create respirable particles).
If required, patients can use nebuliser admixtures of drugs to reduce inhalation time.
The authors recommend nebulisers as first choice in acute exacerbations of airway diseases. Longer inhalation times, compared to dry-powder inhaler (DPI) and MDI, help parents and children to relax in the acute situation.

Advantage Nebuliser:                

  • Suitable for tidal breathing
  • Approved for all ages
  • No coordination required
  • Suitable for emergency use
  • Nebuliser solutions available for many drugs

Hypertonic saline

Nebulised hypertonic saline (HS) is a cost-effective and well tolerated therapy. Bronchiolitis patients treated with nebulised saline in conjunction with bronchodilators benefit from reduced length of hospital stay.

Early administered, hypertonic saline can help to prevent exacerbations in cystic fibrosis (CF) patients.


Nebulisers are first choice therapy in acute cases offering children a safe and reliable application of medication. The nebulisation of hypertonic saline is cost effective and well-tolerated and can prevent pulmonary exacerbations. So far there is no common recommendation for a specific concentration of hypertonic saline. The reported results in children encourage the conduction of further long-term studies in the near future.

Weisner et al; Pneumologie 2013 10:126-133