Dear Dr. K: How can I be sure my four-year old asthmatic daughter actually gets her rescue inhaler dose?

That is an excellent question and one that all parents of asthmatics should ask themselves.

There are actually several ways to answer your question. On a very practical level, if the symptom you were treating (cough, wheeze, shortness of breath) goes away within a few minutes of the treatment, then most likely, your daughter got the medicine and it helped. Also, most of the rescue medicines have mild side effects, especially increasing the heart rate and causing a slight hand tremor.

You could check her pulse before and after the inhalations to see any change.

Your best bet to ensure medicine delivery is to use proper technique. Most research studies looking into whether or not parents use proper technique reveal that only about 10 percent are doing everything right.

The crucial steps include:

1. 1.  Shake the inhaler before use.
2. 2.  If the inhaler is new “out of the box,” be sure the indicated priming has been done.
3. Make sure a good seal is made with the spacer.

              a. For young children the spacer has a face mask that covers the nose and mouth.

              b. For somewhat older children the seal is made by ensuring the lips cover the mouthpiece.

1. 4.  Do one puff at a time.
2. 5.  Have the child exhale first, then deliver puff.
3. 6.  Take six slow, deep breaths for the first puff.
4. Wait 30 seconds between puffs.
5. Then repeat steps 5 and 6. If you’re still not sure, bring your spacer and medicine to the next visit with your pediatrician, pulmonologist or allergist, for a critique of your technique.