Face masks, rather than mouthpieces, are necessary when using holding chambers with children aged less than 2–3 years. This, however, allows nose breathing, which reduces the lung dose. Mouthpieces provide more efficient drug delivery to the lungs, and should therefore be used in preference to face masks as early as possible (O'Callaghan and Barry, 2000).

The delivery of budesonide (Pulmicort^®) via NebuChamber^® with face mask in children aged 1–4 years and via NebuChamber with mouthpiece in children aged 5–8 years (Janssens et al,1999) has been reported. In the younger children, the mean filter dose was 41.7% with NebuChamber and the variability in dosing was 34%; in the older children, the mean filter dose was 50.2% with NebuChamber and the variability was 23%. This shows that the delivered dose is not greatly reduced when using a face mask with NebuChamber, but variability in delivered dose slightly increased.

Overall, the highest delivered doses and lowest dose variabilities are seen with smooth, round masks that provide a good fit over the mouth. However, the face mask should be replaced with a mouthpiece as soon as a child is able to use it (O'Callaghan and Barry, 2000).

References

O'Callaghan C, Barry PW. How to choose delivery devices for asthma. Arch Dis Child 2000;82:185-7.

Janssens HM, et al. Variability of aerosol delivery via spacer devices in young asthmatic children in daily life. Eur Respir J1999;13:787-91.