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Do smaller children need smaller doses of ß-agonist inhalers?


Many thanks. Totally agreed to the physical difficulties of forcing an inhaled medication through a small airway in this age group . My only reservation is the amount of beta-2 agonist systemically absorbed in oropharynx otherwise . Even the best inhaler device system can only deliver about 30% down the airway in adults . Clearly , in the situation of acutely worsened symptoms, the 10 puffs or more via spacer(or half of a volumatic) is well indicated but it also means the child will need further urgent assessment. Certainly, restlessness and tachycardia will be potential side effects if 30 to 40 puffs of salbutamol is used a day . I suppose the same dilemma is applicable to inhaled steroids in these under four years old if the diagnosis of viral wheeze is replaced by bronchial asthma , which is why the latter is such a well known challenge all the time. And I can see why leukotriene receptor antagonist i.e. Montelukast is favoured by many(especially if there is component of rhino-sinusitis for the symptoms).

Posted date

07 Mar 2018

Posted time