For mild to moderate acute wheeze, salbutamol by metered-dose inhaler with a spacer, and a mask in younger children, is at least as effective as a nebuliser, with less tachycardia and shorter time in the department. Nebulisers are needed mainly when a child needs oxygen-driven delivery or cannot use a spacer. Teaching the spacer technique in the clinic also prepares the family for the next attack at home.
- Use an inhaler with a spacer for mild to moderate wheeze in children.
- Add a face mask for children too young to seal a mouthpiece.
- Reserve nebulisers for severe attacks or when a spacer cannot be used.
- Teach and check spacer technique before discharge.
Why it matters
Spacers are cheaper, cause fewer side effects and are what the family will use at home.
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