October 2022: Baby Breathing Treatments—Are We Doing Them Wrong?

Children under 2 years of age who are wheezing may or may not have bronchiolitis syndrome. They could be experiencing the first wheezing episode of a young, aspiring asthma patient. Nevertheless, both conditions deserve treatment trials with a bronchodilator, yet there is significant concern in the literature that infants under 2 years old are less responsive to bronchodilator medications than older patients.This concern primarily stems from a perception of decreased responsiveness to medication in bronchiolitis patients. Truthfully, the vast majority of first-time wheezing episodes in children are associated with viral infections, which are well documented to increase the likelihood of treatment failure in asthma patients.Is it possible that the standard nebulized bronchodilator treatment with a fenestrated mask is even less effective in infants? It is well known that the amount of medication delivered via nebulization is approximately one-third of the medication initially placed in the canister. The remaining two-thirds ends up as aerosol waste and is lost in the atmosphere.A bronchodilator delivery method that delivers close to 100 percent of the administered medication is the metered dose inhaler (MDI) combined with a spacer device or valved holding chamber (VHC). Because they provide a closed system, metered dose inhaler and valved holding chamber devices guarantee that almost all of the dosed medication is delivered to the patient. Only exhaled medication is lost if a s...
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