Update on inhalation therapy in asthma and obstructive bronchopulmonary diseases

: Significant changes have occurred in aerosol therapy in the last few years. New devices have been developed to facilitate the administration of bronchodilator or anti-inflammatory drugs into the airways. Metered-dose inhaler with or without a spacer or powder devices are now considered the ideal mode of administration of aerosolized medications in the regular treatment of child or adult asthma as well as in COPD. In mild to moderate acute asthma, bronchodilators are ideally administered with a metered dose inhaler with a spacer device, nebulisation being required in only a minority of patients. Powder devices such as the Turbuhaler may also be useful in acute asthma but inspiratory flow should be sufficient, and their usefulness in this context remains to be better determined. In severe acute asthma or in patients unable to properly use the other inhalation devices, nebulisation can be used, with oxygen in the case of acute asthma. In patients requiring mechanical ventilation, administration of bronchodilators can be done with a metered-dose inhaler with a spacer device specifically designed for this purpose: it will replace nebulisation in most cases. In young children and infants unable to use spacer devices with a mouthpiece (< 5 years), wet nebulisation is still used during acute attacks of asthma. In these circumstances, the use of metered-dose inhalers with a spacer and mask are probably appropriate in some children but further studies are required to recommend their use.