Tag Archives: childhood asthma

Are you worried about use of Nebulizer for your child? Read on

Nebulizers: Myths and Facts

In my Clinical practice I have seen so many parents and relatives of young children saying “NO to Nebulization”. Many parents do not want to nebulizer their kids as they think it causes addiction and is meant only for severe asthmatic patient.

Any person who is new to nebulization may have some misconceptions (especially lots of myth in public). The aim of this blog is to clear them.


What is Nebulizer?

It is a device which delivers liquid medicine in form of a mist inhaled in to the lungs. It is battery/electricity operated. Patients breathe through mouthpiece or face mask. They come in different shapes and sizes and create sound (as driven by a motor).

 nebulizer (mayaclinic.in)


Myth #1: It will cause addiction and will have to be used every time.

Fact: Nebulization is a mode of delivering a medicine. It does not cause addiction. Addiction is a attribute of drug (or medicine); it does not depend on mode of delivery. If any medicine has addiction potential, it will be for every mode of delivery i.e. oral, intravenous, intramuscular etc.


Myth#2: It is very strong i.e very high dose of medicines given through it.

Facts: Doses of medicine is very less as compared to oral medicine.  As drug goes directly where it is intended lower dose is needed. (Up to 100 to 1000 times less dose is needed in nebulizer as compared to oral or intravenous medicine).


Myth#3: It has more side effects

Facts:  Side effects are far less with nebulizers. As the drug is delivered directly into the lungs where it has to act; hence side effects are less. Whereas oral medications in form of syrups and dispersal tablets first goes into stomach where they are absorbed and then distributed in body so side effects are more.


Myth#4: It takes longer time for drug to start acting.

Facts: Wrong.  As the medicine is going in form of mist directly into the lungs, so it will act faster and give relief much more quickly than oral medication.


Myth#5: It is very expensive.

Facts: No, the cost of each vial of medicine is very low as compared to oral medicines. And in case condition of child worsens than cost of one day of hospitalization will be much more than entire course of nebulization.

Myth#6: It is used ONLY for ASTHMA patients.

Facts: Nebulization is used in many conditions in children eg. Bronchiolitis, Wheeze associated lower respiratory tract infection (WLARI), RSV infection, emphysema. Most commonly it helps via dilating respiratory passage (bronchodilation) or decreasing edema (in case epinephrine is used). For children it is difficult to spit out sputum, so use of nebulization might help.


Myth#7: It is very complicated.

Facts: It is very simple and easiest way. You just have to connect the tubing with mask and fill the medicine and turn on the device. Child can breathe normally; no need to take deep breathing. Even your child can do it on its own and may feel like it’s a playful activity rather than and forceful thing (giving oral medicines). Inhalers are more complicated for children.


Myth#8: Proper dose is not delivered via nebulizer as most of it will go in air.

Fact: Nebulizers are considered as the best way to deliver the medicines in children (in case of hyper reacting airway illness). With inhalers you need to coordinate breathing with medicine dispersal. Oral medications can have erratic absorption as it depends on condition of gut (stomach upset can lead to poor absorption of medicines).

 nebulizer kids(mayaclinic.in)

Myth#9: You have to carry your nebulizer with you.

Fact: Now, so many portable ones are there, so it is very easy to carry them.

 nebulizers 3 clinic

Myth#10:  My baby is very small, it may harm the baby.

Facts: No. Smaller the baby more difficult it s for them to take out their flem. Nebulization will help them to take out all the secretions as it  will dilate the  respiratory passage. Nebulization will not harm your baby.

And lastly have faith in your doctor; they will not advise anything that is not good for baby. Remember both parents and doctors want your baby to get well soon.


 nebulizaion (mayaclinic.in)


Feel free to contact your child specialist or contact us at MAYA CLINIC.


Dr Rahul Varma

” Healthy Kids, Happy Family”

Asthma in children

child-asthma     ASTHMA_kid

In this disease airways are hyperreactive, which means that there is narrowing of airways which leads to difficulty in breathing.

By definition, Asthma is a chronic inflammatory disorder of the airways, characterized by recurrent, reversible, airway obstruction. Airway inflammation leads to airway hyperreactivity, which causes the airways to narrow in response to various stimuli, including allergens, exercise, and cold air.

Most common symptoms of Asthma is Wheezing but all asthmatic children do not wheeze. Most common symptoms of recurrent airflow obstructions are

  • Recurrent wheeze (wheeze is heard by stethoscope but sometimes audible whistling sounds )
  • Recurrent isolated cough
  • Recurrent breathlessness
  • Nocturnal cough
  • Tightness of chest

Signs are (examination by doctor):

  • Generalized rhonchi (wheezing sounds heard with a stethoscope)
  • Prolonged expiration
  • Chest hyperinflation (on X ray of Chest)


The Ten Commandments of Asthma


  • Asthma is a chronic condition with episodic symptoms. There is a need for continuous preventer drugs for certain grades of asthma. The drugs used for asthma ‘control’ asthma but do not ‘cure’ asthma.
  • A majority of children outgrow their symptoms as they grow older.
  • There are lots of myths and misconceptions regarding inhaled therapy which need to be cleared. Medications given using inhaled route have their own merits and advantages.
  • Discuss the selected regime and address concerns regarding usage of medications with your doctor.
  • Discuss the usage and maintenance of the inhaler device selected.Carry the inhaler device at each follow up visit.
  • It may take some time taken to note improvement and need for compliance with the prescribed preventer drugs cannot be over-emphasized.
  • Dealing with triggers / precipitants like dust, pollen, fur, smoke, exercise etc can go a long way in controlling the symptoms, and preventing asthmatic attacks. Diet has a small role in causation of symptoms.
  • Maintain a diary of events and carry it at each follow up visit. Record days that there are events such as daytime cough, nocturnal cough, wheeze, reliever medication use, doctor/hospital visits, school absenteeism due to symptoms etc.
  • Learn how to manage acute exacerbations/ sudden asthmatic attacks at home prior to doctor contact.
  • Go for the follow up visit 2-4 weeks after institution of preventer regime. Subsequent visits may be planned 2-8 weekly according to the severity or earlier in case of recurrences, or as your specialist plans.

The eleventh commandment (During follow up)

  • Identify any lacunae in understanding and clarify all doubts in subsequent meetings.


Advantages of the inhaled route (MDI pump and nebulizers) are

  • ‘Smaller dose’: Contrast the milligram (mg) concentration of syrups and tablets with the microgram (mcg) concentration of the same drug in the inhaled form.
  • ‘Target delivery’ – ‘Quicker action’: Drug is delivered directly to the site of action. Reliever drugs, therefore, act faster.
  • ‘Safer’: Smaller dose and thus, much better safety profile than with oral therapy. This is particularly relevant for steroids.

Misconceptions which need to be cleared

  • Is inhaled therapy addictive?  I want to emphasize that addiction liability is a property of the drug rather than device / route. Example that alcohol, though oral, is still addictive. None of the asthma medications are known to cause dependence.
  • Is inhaled therapy strong? No, as discussed earlier, smaller dose is needed (microgram concentration) of drugs used.
  • Is inhaled therapy expensive? The inhaler device is a one-time purchase. Only drugs need to be purchased subsequently. A few inhaled drugs may be slightly more expensive than oral drugs on a per dose basis but these in the context of the child’s well being, safety and reduced doctor / hospital visits are better option.
  • Are inhalers easy enough for children to use? MDI pumps used with spacer can be given to small children also with ease and technique is very easy.

Typical features of this disease

  • Afebrile episodes (most cases)
  • Personal atopy or skin allergy
  • Atopy / Asthma in a parent or sibling
  • Exercise / Activity: In a smaller child, laughing or crying may provoke symptoms.
  • Triggers: These are usually inhaled irritants or aeroallergens (page 10).
  • Seasonality: Sudden temperature changes, flowering season and harvesting time are risk situations. This feature can be judged only after observation over a sufficient time period.
  • Later onset of symptoms (usually around 3 years of age)
  • Relief with bronchodilator (asthalin )± short-course oral steroid

In children, asthma is a clinical diagnosis, made by evaluation over time, either retrospectively or prospectively.

Investigations help in confirming or ruling out alternative diagnoses, rather than in diagnosing asthma.

Asthma Poster

Classification of asthma, Treatment protocol and whether asthma is well controlled or poorly controlled can be read in detail by reading the below mentioned link.

As per management of asthma, there are plenty of medicines which can be given by different routes . So discuss in detail with your Child Specialist / Pediatrician regarding what is best for your child.

Most of the children outgrow this disease with proper treatment and live symptom free life. There are plenty of sports persons who had asthma and they still compete at international level.

Our positive mind set along with caring attitude and emotional support for children can give them symptom free childhood.

If you are interested in reading in detail regarding this disease (that to especially in Indian scenario), than read the guidelines of Indian Academy of Pediatrics. Below is the link for that.


For any queries feel free to contact at Maya Clinic or discuss with your child specialist.

“Healthy kids, Happy family”


Dr Rahul Varma