With parental assistance and use of a spacer, young children can correctly use a novel propellant-free metered-dose inhaler to treat respiratory conditions, German investigators reported.

Only one of 99 children aged younger than 5 years did not use the Respimat® Soft Mist™ inhaler correctly. Technical failure occurred as a result of the child's refusal to cooperate rather than an inability to use the inhaler, Wolfgang Kamin, MD, Children's Hospital, Hamm, Germany, and colleagues reported.

The Respimat® Soft Mist™ is a handheld, multidose, propellant-free inhalation device that generates a slow-moving cloud that contains a high, fine-particle medication dose. Because spray generation is independent of inspiratory flow, the device might afford opportunities to treat young children with respiratory disorders.

To assess the ability of young children to use the novel inhalation device, investigators at two centers in Germany recruited 99 pediatric patients with a variety of respiratory disorders. The children were grouped by age (<1, 1 to <2, 2 to <3, 3 to <4, and 4 to <5 years) and their inhaler usage skills were evaluated by direct observation of the investigators.

Dr. Kamin reported that all but one child aged younger than 3 years were able to use the Respimat® Soft Mist™ correctly with a spacer. Additionally, 23 of 27 (85%) children aged 4 to 5 years were able to use the device correctly without a spacer, but only 12 of 30 (40%) children aged 3 to 4 could use the Respimat® Soft Mist™ correctly without a spacer.

When paired with the spacer, all children in the 3 to 4 year and 4 to 5-year age groups could use the inhaler properly. Rates of correct usage decreased without parental assistance.

“The majority of subjects aged 4 to 5 can handle the Respimat® Soft Mist™ inhaler without a spacer but with considerable variability in technique,” Dr. Kamin concluded. “Thus, to ensure standardized dosing, children below 5 years of age are recommended to use the Respimat® Soft Mist™ inhaler with a spacer.”

In general, patient and parental satisfaction with the Respimat® Soft Mist™ inhaler was high, with or without the spacer. Satisfaction rates for reliability, instructions, ease of use, and overall ability to use the inhaler were 90% or higher, declining to 75% when children were handling the device alone. The Respimat® Soft Mist™ inhaler plus spacer had satisfaction rates that ranged from 83% to 97% for all components of use.