A 4-year-old with a 2-year history of recurrent wheezing is prescribed an inhaled corticosteroid (ICS). Which device is MOST appropriate for delivering ICS in this age group?

• A Dry powder inhaler (DPI) without a spacer
• B Nebuliser with a mouthpiece
• C Breath-actuated inhaler (BAI)
• D Pressurised metered-dose inhaler (pMDI) with a valved holding chamber (spacer) and face mask ✓

Explanation

For children aged 1–5 years, pMDI with a valved holding chamber (spacer) and face mask is the preferred and most effective delivery device for inhaled medications including ICS. Young children cannot coordinate breath actuation with inhalation required for DPIs or BAIs. A spacer with face mask removes the need for coordination, ensures adequate lung deposition, and reduces oropharyngeal deposition (and thus systemic absorption). Nebulisers are used in acute severe asthma or when spacer is not feasible but require long administration time and are not preferred for home maintenance.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.