TWO or three tidal breaths are sufficient to deliver asthma medication to young children using a spacer, research suggests.

Working with children aged two to seven, respiratory physicians from Princess Margaret Hospital for Children in Perth have discovered youngsters tend to take much larger breaths than normal when using a spacer or valved holding chamber device.

Experimenting with two small-volume devices – Funhaler and AeroChamber Plus – the researchers found no significant difference in drug delivery between two tidal breaths and nine tidal breaths (39% vs 38%).

With larger-volume devices, a Volumatic and a modified 500 ml plastic soft drink bottle, delivery of the aerosolised medication was significantly less, with two breaths compared to nine (37% vs 43%), but not significantly different from three (40%) to nine breaths.

Princess Margaret Hospital staff specialist Dr Andre Schultz said guidelines gave no specific recommendation on the best way to use spacers, and doctors varied in the advice they gave.

“In Perth I think most doctors would probably say take five breaths, but it varies, and there’s never been a gold standard,” Dr Schultz said.

The researchers also query the use of masks with spacers in children aged under four, as much of the drug ends up being deposited in the nose and upper airway.

“Any child from about two years of age can be trained to use a spacer without a mask if they are shown how to seal their lips around the mouthpiece,” Dr Schultz said.

The finding in favour of two or three tidal breaths would apply to most spacers, depending on size, but would not necessarily apply to mask wearers because the interface with the device is different, and a child’s breathing pattern may change, Dr Schultz said.

Young child spacer recommendations

• For small-volume spacers, two tidal breaths

• For larger Volumatic chambers, three tidal breaths

Pediatrics 2010, in press