Q: “My 6-year-old son has asthma and needs to use a nebulizer when he is sick. He hates it, though. Is there anything I can do to make it easier for him?”

Purvi Parikh, MD: If your son really dislikes using his nebulizer, the first thing I would recommend is asking your allergist about whether he could use a metered-dose inhaler with a holding chamber (sometimes called a spacer) instead. This would ease any discomfort he has from sitting still for 15-20 minutes for the treatment.

At 6 years old, your son is probably able to use the correct inhaler technique, after some coaching from your allergist or pharmacist. Teach and practice inhaler technique even when he’s feeling well, so it’s easier when he’s ill.

If your allergist still wants him to use a nebulizer, ask about using one with a mouthpiece (sometimes called a t-piece) instead of a mask. At his age, he should be able to hold it in his mouth comfortably during the treatment, and it relieves the claustrophobic feeling of the mask.

The good thing about a nebulizer is that it’s a very passive device and doesn’t require any effort. He just breathes normally through the mouthpiece and the medicine flows easily into his lungs. You might be able to keep him still by allowing him to watch a movie or play a video game during treatment.

Q: If he needs a nebulizer treatment at night, can I give it to him while he’s asleep?

Dr. Parikh: That’s a great question, and the answer is yes, you can. This is a good time because he’s relaxed, he’s breathing deeply, and he’s not likely to fight against it. You might be able to slip a mouthpiece into his mouth without waking him too much.

You can also use a mask and either hold it up to his face or strap it on. The thing about a mask is that you want to make sure the medicated mist goes into his mouth or nose and doesn’t drift up into his eyes, so it requires a tight fit.

Do not just waft the medicine in front of his face, though, and hope that he inhales some of it. This “blow-by” technique will not give him a good dose of the medicine.

Q: What’s the most important thing to know about nebulizer treatments?

Dr. Parikh: Make sure the medication is getting into the child’s nose or mouth either through the mouthpiece or the mask, and use a device that the child is comfortable with.

Also, follow your allergist’s instructions about how often to use it and how much medicine to use; and follow the device manufacturer’s instructions about keeping the unit clean and replacing the tubing and mouthpieces as necessary. A dirty unit can accumulate germs, dust mites and other allergens that can worsen asthma instead of helping it.

Purvi Parikh, MD, FACAAI, is an allergist and immunologist in New York City at Allergy and Asthma Associates of Murray Hill and New York University School of Medicine. She sits on the Board of Directors for the advocacy council of the American College of Allergy, Asthma & Immunology (ACAAI).

Have a medical question? Email editor@allergyasthmanetwork.org or write to Ask the Allergist, Allergy & Asthma Network, 8229 Boone Blvd., Suite 260, Vienna, VA 22182.

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